Dallas City of Learning Partner Interest
Organization Name
First Name
Last Name
Preferred First Name
Your Title in the Organization
Primary Address Type
Please select...
Billing
Shipping
Street Address
City
State
Zip Code
Preferred Phone Type
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Mobile
Work
Other
Preferred Phone Number
Secondary Phone Type
Please select...
Mobile
Work
Other
Secondary Phone Number
Preferred Email
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Personal
Work
Alternative
Email Address
Secondary Organization Representative
First Name
Last Name
Email
Organization's Website
An active website is required
x
Upload your organization logo here. We can accept .jpg, .png and .gif file types.
Briefly describe the Organization's mission or vision:
What age groups does your organization typically serve?
(check all that apply)
Ages 0-4
Ages 5-9
Ages 10-12
Ages 13-16
Ages 17+
What types of programs does your organization typically offer?
(check all that apply)
Civics & Service
Social & Emotional Foundations
Academics & Artistry
Digital Fluency
Design Thinking
Community Resources
Other
If Other, please specify:
How are your programs presented? (
check all that apply
)
In Person
Hybrid
Virtual Synchronous
Virtual Asynchronous
Is your organization M/WBE
(Minority/Women-owned Business Enterprises)
Certified?
Yes
No
If not, are you interested in
pursuing M/WBE Certification
for your organization?
Yes
No
How did you hear about becoming a Program Partner?
Please select...
Referred by Big Thought staff member
Friend or colleague
Dallas City of Learning website
Big Thought website
Saw Dallas City of Learning at an Event
Saw Big Thought at an Event
Social media
Other
Referral Source Name
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Contact Information