Support Group/Coop Information

Organization Information
Name:
Email Address:

Website:
Email Group:
Address:
City: State:
Phone:
Fax:

 

Individual Contacts
Person
First/Last 		Position Phone Email
 

 
 
 

 

Services offered by your organization
Organization Type

Requirements
yes no Support
yes no Co-op
yes no Other

 

Organization Information
Church Affiliation:
Statement of Faith Agreement Required: (Select all that Apply) Student/Parent: yes  no Teacher: yes no Board Member: yes no
Other (explain):
Age Groups: (Check all that apply) pre-school    lower-elementary   upper-elementary  middle school   high school
Membership/
Registration Fees:		 Fee Amount:                 Frequency: semester  annual
Other Fees:
Meeting Days and Frequency:
Geography: Meeting Place:  
Area Members are predominately from:

 

Description/Mission/Goals:
Please include any information to describe your groups mission and activities.

You may also send a gray scale logo and or a picture to include with your group's description.  Please email the graphics as attachements to contact@sahero.org.

Person we may contact if we have any questions:

Name:
Phone:
Email: