Partner Assistance Request
Let us know how we can help you!
Your Full Name
*
First Name
Last Name
Your Phone Number
*
Please enter a valid phone number.
Your Email Address
*
example@example.com
Your Role Overview (Ex. Administrative Assistant)
*
What are your needs? (Check all that apply)
*
Financial Support
Guest Speaker
Group Mentoring
Direct Program Involvement (e.g., supplies and materials)
Site Visits
1-on-1 Mentoring
Field Trip Support
Tutoring (Tutors will need to attend an orientation and provide sign in logs)
Other
Name of Club or Event
*
Please provide a brief overview of the purpose of this event. Include details about the individuals impacted by this event, as well as the learning objectives and activities planned.
*
Has this been approved by all administrators?
Yes
No
List the name of the administrator who approved this below. (ex: Principal, Chief Academic Officer)
*
List the names of GAPS staff member(s) you are collaborating with on this request.
*
Parties Participating
*
Total Participants
Back
Next
Guest Speaker Program (Only complete if you selected 'guest speaker' above)
Provide a list of topics you would like the guest speaker to address.
Describe the background, experiences, and other qualifications you believe are important for the speaker to have.
Provide details regarding any desired Excursions (Only complete if you selected 'field trip support' above)
Where would you like to go?
When would you like to go? Provide time frames and days (e.g., after school, weekends)
What resources are necessary for the trip to be successful (e.g., contacts, admission fees, transportation, food, etc.)?
Estimated Resource Needs & Budget* Please be specific and detailed.
List Items for Resource Allocation
*
Total Cost
*
Other information. Provide any additional information regarding your planned activities, needs, requests, etc. that may be useful in processing your request.
*
Support Terms & Conditions
*
I Accept Support Terms and Conditions
Payment Information
Provide information below regarding payment details. (Acceptable form of payment & corresponding information.)
Requested by:
Printed First and Last Name
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: