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2022-23 MEMBERSHIP FORM

It is important that we have up-to-date information about our members! Please help us with this by completing the form below if there has been a change in your organization's information (leadership, address, enrollment, etc.). Thank you!

1.

*

Organization Name & Abbreviation:

2.

*

The number of public school districts and public charter schools you serve in your service region:

Less than 10

11-25

26-50

51-75

75+

3.

*

Organization Employee County (number of employees including all full- and part-time employees---not FTEs):

1-5

6-24

25-199

200-499

500+

4.

*

Total number of students attending public schools and public charter schools in your region:

10,000 or less

10,001 - 25,000

25,001 - 50,000

50,001 - 100,000

100,000+

5.

*

Annual Budget:

Less than $5 million

$5-$10 million

$10-$25 million

$25-$50 million

$50 million+

Organization Information

6.

*

Web Address:

7.

*

Address:

8.

*

City:

9.

*

State:

10.

*

ZIP:

11.

*

Phone:

12.

Twitter Handle:

CEO/Executive Director/Superintendent

13.

*

Name:

14.

Address (if different from above):

15.

*

Phone:

16.

*

Email:

17.

Twitter Handle:

CFO/Business Manager

18.

*

Name:

19.

Address (if different from above):

20.

*

Phone:

21.

*

Email:

Executive Assistant

22.

*

Name:

23.

Address (if different from above):

24.

*

Phone:

25.

*

Email:

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2022-23 MEMBERSHIP FORM