Project Reconnect Sign-Up Form
Sign in to Google to save your progress. Learn more
Name *
Organization Name *
Organization Address *
Lead Contact Name *
Lead Contact Email *
Lead Contact Phone *
What is your organization's mission statement? *
What age group does your organization serve?
If applicable, what zip codes does your organization serve?
If applicable, what schools does your organization work with?
What is your organization's capacity to provide the requested services? *
I understand that participating organizations must comply with all MNPS Policies and Procedures. *
Required
My organization can meet and document all insurance requirements as stated in MNPS Data Contract *
Required
My organization's staff that will be working on this project are committed to attend a one-time training prior to the start of the Project period on Thursday, August 26th from 9am - 11am. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Alignment USA. Report Abuse