SLATE-Z Partnership Interest Form
Thank you for your interest in the SLATE-Z partnership. Please fill out the form below and we will respond to your request as soon as possible.

If you have any questions regarding the form, please contact SLATE-Z Partnership Coordinator, Cindy Hwang at hwangc@lattc.edu.

Email address *
Name *
Your answer
Organization *
Your answer
Contact Phone Number *
Your answer
Organization Address *
Your answer
Organization Website *
Your answer
What is the mission of the organization? *
Your answer
Focus *
List the Top 5 services offered by the organization.
Your answer
List the Top 5 services data collecting measurements (e.g. Number of families served) *
Your answer
What methods are used for outreach/publicity? (Check all that apply) *
Required
What type of funding does the organization receive? (Check all that apply) *
Required
How did you learn about the Promise Zone? *
Your answer
Are any of your Community Partners part of the Promise Zone Partnership? *
If yes, please list the organizations.
Your answer
Tell us briefly why the organization is interested in joining the Promise Zone partnership? *
Your answer
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