*1.Enter the name of your organization (Required.)

*2.Enter your organization's webpage or website link(Required.)

*3.Enter the contact person for your organization(Required.)

*4.Enter the contact person's phone number (work and cell)(Required.)

*5.Enter the contact person's e-mail address(Required.)

*6.Please select your organization's geographic reach(Required.)

Domestic (U.S.A)

International 

*7.Please select your organization type(Required.)

Community-Based Organization

Local Education Institution

International Education Institution 

Government Agency

Foundation or other administer of funds

Other (please specify)

*8.Please choose a virtual offering (if applicable)(Required.)

30- Minute Q&A (No presentation or Overview)

1-Hour Information Session (HCZ Overview, History, and Culture)

2-Hour Program Presentations (Overview and 1-2 Specific Areas of Interest)

4-Hour Program Presentations (Overview, 2-4 Specific Areas of Interest, Deep Dive Q&A)

Gold Star 4-Hour General, Opening the Vault (Project activities, planning, and scheduling with breakout sessions)

N/A

*9.Please choose an in-person offering (if applicable)(Required.)

1-Hour Information Session (HCZ Overview, History, and Culture. No visit to programs) No fee. Conversation only.

3-Hour Site Visit (For groups of 6-12 people only, $3,000) Program presentations with option to visit program(s). 

1-Day Learning Series (For groups of 6-12 people only, $6,000) Program Presentations with Site Visits.

2-Day Learning Series (For groups of 6-12 people only, $8,000) Program Presentations with Site Visits.

3-Day Learning Series (For groups of 6-12 people only) $10,000. Program Presentations with Site Visits.

N/A

*10.Please describe the neighborhood/community you currently serve/intend to serve (size, economic status, density, etc.)(Required.)

*11.What is your community's strength(s)?(Required.)

*12.Briefly describe your organization and partner organizations that will participate in the visit to the Harlem's Children's Zone(Required.)

*13.Why does your organization want to visit?(Required.)

*14.How many years has your organization been in existence?(Required.)

*15.What is your organization's budget?(Required.)

*16.What are your primary funding sources? Please list the percent of your funding that comes from private and public sources.(Required.)

*17.How many employees (full-time and part-time) does your organization employ?(Required.)

*18.What element(s) of the Harlem Children's Zone model most interest you and why?(Required.)

*19.How did you hear about Harlem Children's Zone? (website, social media, news article/tv segment, book, friend or colleague, college, etc.)?(Required.)

*20.Are you affiliated with any federal initiative (i.e., Promise Neighborhood, Choice Neighborhood, NRI, etc.)?(Required.)