Success Bound Partnership Commitment Form

Success Bound School Partnership Commitment Form
This commitment form establishes your official partnership with Success Bound as a Digital Partner, granting your school access to our full curriculum. We look forward to working closely with your school to support student success this year and beyond!

Please carefully review the information in this form.
Where is your school/organization located?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is your role at your school?*

PrincipalAssistant PrincipalSchool CounselorOther

Success Bound pledges to support you to reach your Success Bound goals by providing:
- Access to the 6-8th grade curriculum including unit plans, lesson plans, slide decks and student facing materials on Successbound.org
- Access to additional implementation resources and digital training videos on SuccessBound.org
- Customer service response to questions emailed to info@successbound.org

1. Email*
example@example.com
2. Full Name*

First NameLast Name
3. School/Organization Name*
Total Number of Middle Grade Students*
NCES School ID (Organizations enter N/A)*
To find your NCES School ID CLICK HERE
Staff Member (Success Bound Site Director) who will coordinator Success Bound at your School/Organization?*

First NameLast Name
Success Bound Site Director Email*
example@example.com
Success Bound Site Director's role within the school building
Implementation Model

In-school programming (Advisory, Core Content, etc)After-school programmingMentoring programStudent support group
How does Success Bound align with your school's or organization's mission and/or goals?*

As a Success Bound Partner School, we pledge to…*

Rows	We will make an intentional effort to reach this goal.
Demonstrate a belief in all students to reach their middle school, high school and postsecondary goals.
Provide opportunities for all middle grades students to explore postsecondary options and connect to the world.
Bring our school and parent communities into our Success Bound work.
Deliver the Success Bound curriculum to our 6th-8th grade students.
Work toward a team implementation approach, where all middle grades teachers and/or staff are an integral part of the program.
Annually complete Success Bound’s requests for additional information to update the contact person for the Institution, the number of students impacted, the implementation model used by Institution, and a statement of alignment between SB and Institution’s missions.
All intellectual property (including, but not limited to trademarks, copyrights, inventions, information and proprietary rights and processes and/or derivative works) (collectively "Intellectual Property"), if any, developed in connection with this MOU will be the sole property of SB. Institution expressly agrees that SB is the owner of all Intellectual Property related to the Program, and Institution’s use of such materials does not in any way transfer ownership of any material, concept, or other form of Intellectual Property to Institution. The unauthorized distribution or sub-licensing of Intellectual Property is strictly prohibited.

(Optional) Provide any additional information or questions here.
This Agreement merely constitutes a statement of mutual intentions, and therefore does NOT constitute a binding agreement upon any party.
Signature*
Annual Pledge Signed

TRUE
Program Engagement Record Type
Program Name - For SF Integration, Need to Change Annually
National Program Name
Chicago Program Name (No Longer Using)
National Program Engagement
Chicago Progam Engagement
Where is your school located? [previous field]*
city & state fields needed instead for SF integration
Network
2. Full Name
replaced for SF integration to capture first and last name
Principal or Assistant Principal Signature
Should be Empty:

Success Bound School Partnership Commitment Form