About your School
School/Organization Name:
*
School/Organization Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Type
Charter
Independent
Public
Religiously-Affiliated
Number of Students Served
*
% of students who qualify for the Free and Reduced Lunch Program or tuition assistance
*
Does your school receive Title 1 funding?
*
Yes
No
Student Demographics
% of student body
American Indian/Alaska Native
Asian
Black
Hispanic
Native Hawaiian/Pacific Islander
White
Two or More Races
Unknown Race
Your Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Financial Assistance Request
Please indicate which Challenge Success program or service you are requesting.
*
Please describe how this Challenge Success program or service will benefit your community and how it aligns with your long-term priorities.
*
Please provide information describing your budget and need for financial assistance.
*
Please indicate how much you can contribute financially to the Challenge Success program fee or service you are requesting.
*
SUBMIT
Should be Empty: