Living Strong Consulting LLC
Pre-Engagement Information Form
Organization Name *
Your answer
Contact Person *
Your answer
Address *
Your answer
Telephone *
Your answer
e-mail address *
Your answer
Briefly describe your request for services and support *
Your answer
Current needs/barriers within the organization *
Your answer
Projected start date of the project *
MM
/
DD
/
YYYY
Desired Goals/Outcomes for the project *
Your answer
Projected number of hours for the project
Your answer
Type of service requested (check all that apply) *
Required
How many additional hours per week do you have to dedicate to this change process?
Your answer
Number of Staff/Employees
Your answer
The Section Below is for Educational Programming Only
Program Capacity
Your answer
Do you participate in any of the following initiatives?
YES
NO
STARS
NAEYC
COA
Success By 6
Universal Pre-K
Early Head Start
Head Start
CCIS
Pre-K Counts
21st Century CCLC
Primary Age Group(s) Served
Number of Students Enrolled
<5
6-10
11-15
16-20
21-25
>25
Infants
Row 2
Toddlers
Pre-School
Pre-K
K
After-School/OST
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