UCLA Community School Partner Program Proposal Form
Thank you for your interest in supporting a UCLA Community School through enrichment programming!  Please fill out the following questions so we can better understand your program's vision and needs.  Someone from our team will follow up with you shortly.  For further questions, please contact Dr. Christine Shen at <dr.christineshen@gmail.com>.
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Email *
Basic Information
Please provide general information about the UCLA department or organization designing this program, as well as a point person and contact information.
Name of Organization *
Name of UCLA Program Lead *
Will the lead be at all program days?  If not, who will be the designated lead at the site if the lead is not available? *
Are there any other adults facilitating or participating?  List all here.  ***All adults will need to fill out LAUSD volunteer protocol, including a form and a TB test taken within 6 months of starting volunteer work.*** *
Has this organization previously collaborated with a UCLA Community School? *
Program Information
Please describe the scope of the proposed program.
Which school are you interested in partnering with? *
Name of Proposed Program *
Please describe the proposed program (what is the program, what is its vision, what are its goals?) *
Program Logistics
Please fill out the following information regarding your program.  Describe your ideal location, student ages, etc.- know that these may need to be adjusted based on the needs and availability of school resources, but we will try our best to support each program.
Start Date *
End Date *
How often will the program meet per week? *
How many weeks will the program run? *
How long is each session? *
Ages of Students Served *
How many students are you hoping to work with?  (example responses:  one Den 1 Class, all of Den 3, or the program is open to all students TK-12) *
Will your program meet with different groups of students each session, or stay with the same group of students over the course of the program? *
What kind of space/room do you need? *
How will the program be evaluated?  If you need support in designing a program evaluation, we are happy to assist you. *
Is there anything else you would need for the program to run successfully?  Please leave any additional information, requests, or comments here. *
A copy of your responses will be emailed to the address you provided.
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