• EQUIP Provider Application

  • Please fill out this application as completely as possible. All of the requested information will be useful in the determination of our initial cohort. This application can be saved to be finished at a later time.

  • General

  • Operations

  • Owner/Executive Director

  • (If No, then please complete the following. If Yes, skip to Director.)

  • Director

  • Director Support

  • (If No, then please complete the following. If Yes, skip to Program Support.)

  • Program Support

  • Governance & Finance

  •  -  -
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  • Classrooms

  • Staffing

  • Please complete the Staff Roster Grid supplied to you separately. Include all leadership and support staff as well as teaching staff.

  • Leadership & Systems

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  • Financial Statement

    Please upload your program’s financial statement for the last complete fiscal year. Your financial statement may also be called a “statement of profit and loss,” and “income statement,” or an “income and expense statement.” The financial statement is not the program’s budget, but instead itemizes revenue and expense for a 12-month period.
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  • Attestation Statement

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  • Any last comments?

  • Should be Empty: