Partners In Education (P.I.E.) PARTNERSHIP APPLICATION effective November 2018

NOTE:
Thank you for your interest in supporting Prince George's County Public Schools. Please complete all application sections.
Incomplete applications will not be considered. Please answer ALL questions and attach all required documents.
The Office of Community Partnerships does not approve fee-based partnerships. If you charge for your program services, do NOT complete this application. Fee-based programs must contact the Purchasing Department at 301-952-6560.
Email address *
Organization Information
Organization Name *
Organization Description *
Is your organization a non-profit corporation? *
If yes, copy of your IRS Determination Letter must be attached to this application
IRS Documentation Letter (for Non-Profits only)
Contact Name *
Title *
Street Address *
City *
State *
Zip *
Phone (Office) *
Phone (Cell)
Website
Program Information
Program Title *
Program Objective *
Are you currently partnering with PGCPS on another project? *
If you answered yes, indicate Project Name and Schools
Population to be served *
Choose all that apply
Required
If students, select impacted grade levels
School(s) to be served
Choose all that apply (NOTE: You must choose a specific school(s) that you wish to partner with)
Type of program or service:
Choose all that apply
Program Duration (Days and Times) *
Example: Tuesday and Thursday (5-6:30 p.m.) and Saturday (9 a.m. to 12 noon)
Results expected at end of program: *
Strategies to be used: *
Facilities Use Policy

Partnering organizations may use PGCPS school facilities in accordance with policies and procedures. For more information, please visit the PGCPS Facilities Use website (https://www.pgcps.org/plantoperations). Fees will be determined based on the type of use required.
What will PGCPS be responsible for? *
What will your organization be responsible for? *
Program Budget
Due to budgetary constraints, PGCPS is unable to seek or provide funding to support your program; therefore, a copy of your budget, as well as the source of funding, must be attached to this application.
Program Budget File *
Required
Source of Funding *
Required
Safety Requirements:
Partnering organizations must complete mandatory PGCPS safety requirements, per Administrative Procedures 4215 and 4216.6. Requirements include a PGCPS Fingerprint Background check, Child Protective Services (CPS) Clearance, and online SafeSchools Training Modules. For more information, please visit the PGCPS Student Safety website (https://www.pgcps.org/studentsafety). For copies of the procedures, please visit the PGCPS General Counsel website (https://www.pgcps.org/administrativeprocedures).
Verification
By typing my name below, I verify that all information is accurate and that I agree to honor all policies. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of PGCPS. - Terms of Service