DirForm


	PCPO Resource Directory Form

Revised 4/2008


	School Information Section:


			Note: Use the Enter Key to submit form. Use the Tab Key to move through form. Only use the Enter Key when you are ready to submit the form.


	School Name:


	School Phone Number:


	Example: 5031231234


	Is this number for emergencies only?

Yes


	No

(Check yes if the number is only for emergency use.)


	Left mouse button or space bar to insert/remove check mark.


	Facility Name:

This might be the name of the church or center in which the school has its classes.


	School Street Address


	School Mailing Address







	School web address


		Hint: Use the Tab Key to move through form in field order or click and select inside the field box to type over field instruction or example.

	Check box if Street Address is the same as Mailing Address. No need to fill out Mailing Address if they are the same


	School general email address


	Teacher Information Section:


	Teacher one name


	Teacher one information


		Years at this school.

		Years teaching in co-ops.

	Teacher two name


	Note: If the school has more than four teachers, submit this form completely and then submit it a second time with just the school’s name and the additional teacher information.


	Teacher two information


	Years at this school.

	Years teaching in co-ops.


	Teacher three name


	Teacher three information


		Years at this school.

		Years teaching in co-ops.

	Teacher four name


	Teacher four information


	Years at this school.

	Years teaching in co-ops.


	School Officer Information Section:


	President’s name


	President’s information











	Treasurer’s name


	Note: If the school has a co-president, submit this form completely and then submit it a second time with just the school’s name and the additional co-president’s information.


	Treasurer’s information


	Registrar’s name


	Registrar’s information











	PCPO Representative’s name


	PCPO Representative’s information


	General School Information Section:


	Projected membership

	Registration fee

	Monthly rent


	What is the birthday cutoff date for enrollment?


		September 1st, or pre-k is 5 by December 31


	You’re almost done!


	First type of class and ages served


	3’s; or mixed age,3-4; or Kinders, 4 1/2 to 6


	Days the class meets


	T/Th; or MWF; or M-F


	Time of session/s


	9-11:30am and 1-3:30pm would indicate a morning and afternoon session.


	Monthly tuition


	Second type of class and ages served


	3’s; or mixed age,3-4; or Kinders, 4 1/2 to 6


	Days the class meets


	T/Th; or MWF; or M-F


	Time of session/s


	9-11:30am and 1-3:30pm would indicate a morning and afternoon session.


	Monthly tuition


	Third type of class and ages served


	3’s; or mixed age,3-4; or Kinders, 4 1/2 to 6


	Days the class meets


	T/Th; or MWF; or M-F


	Time of session/s


	9-11:30am and 1-3:30pm would indicate a morning and afternoon session.


	Monthly tuition


	Fourth type of class and ages served


	3’s; or mixed age,3-4; or Kinders, 4 1/2 to 6


	Days the class meets


	T/Th; or MWF; or M-F


	Time of session/s


	9-11:30am and 1-3:30pm would indicate a morning and afternoon session.


	Monthly tuition


	Note: If the school has more than four class types, submit this form completely and then submit it a second time with just the school’s name and the additional class types information.


	Use the box below for any clarifications or messages to PCPO.

		Any comment or explanation. It is okay to use the Enter Key in this field.

	Please provide us with your email address should we have any questions, and so we can forward you an email with your data.

One more click and your are done and we really appreciate your time and effort.
After clicking on the SEND button below, we will receive your information and generally within a few day we will send you an email with the information you submitted for your reference. If you find you want to add or change something, just return to the form page and fill in the correct/missing information . Also fill in the school name and a brief message in the box above so we can match the new information with your first submission.


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