Intent to Participate in the 2017 Summer Learning Program
Literacy Mid-South has begun preparing for the 2017 Summer Learning Program. Please complete this form if your organization will like to participate in the Program and receive support from Literacy Mid-South.

The form will close at 5:00 pm on Monday, April 3, 2017.

The form should take about 10 to 20 minutes to complete depending on the needs of your organization's summer programs.

If you have any questions, please contact Johnny Blount at

Outline of Information to Provide
[] Organization

[] Program Locations

[] Program Personnel

[] Program Schedule

[] Assessment Schedule

[] Curriculum and Training Needs

Name and contact information of person completing form
Name *
Your answer
Email *
Your answer
Phone Number *
Your answer
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