Golden Apple Foundation of Rockford

Educational Resources Survey

Section 1: Personal Information
I am a Teacher/ School Official Educational Provider/ Partner Other - please specify
*First Name	*Last Name
*Phone	*Email
Section 2: Education-Partner/ Provider Information
Partner/ Provider is a: Business Parent Group Non-profit Org/ Agency Other - please specify
*Partner/ Provider Name
*Partner Contact Name
*Contact Phone	Contact Fax
*Contact Email	Contact Website
Section 3: Program Information
*Program Name
Program Topic (select all that apply) Art Careers Character Development Community Service Counseling Health Education Leadership/Training Math Mentoring/Tutoring Miscellaneous Physical Education PTO Activities Reading Reading Science Social Studies Writing/Literacy
The program is for which schools? (select all that apply) AUBURN HIGH SCHOOL BARBOUR MAGNET SCHOOL BELVIDERE HIGH SCHOOL BEYER ELEMENTARY BLACKHAWK ELEMENTARY BLOOM SCHOOL BOONE COUNTY CENTER BOYLAN HIGH SCHOOL BROOKVIEW ELEMENTARY CALEDONIA ELEMENTARY CAPRON ELEMENTARY CARLSON ELEMENTARY CENTRAL MIDDLE SCHOOL CHERRY VALLEY ELEMENTARY CHRISTIAN LIFE CIRCLE OF LEARNING CIRCLES OF LEARNING CLARK ELEMENTARY CONCORDIA LUTHERAN SCHOOL CONKLIN ELEMENTARY DENNIS SCIENCE MAGNET DETENTION DOLAN CTR-MARYVILLE CAMPUS DURAND ELEMENTARY DURAND HIGH SCHOOL DURAND JR HIGH SCHOOL EAST HIGH SCHOOL EISENHOWER MIDDLE SCHOOL ELLIS ARTS ACADEMY FAIRVIEW CENTER FLINN MIDDLE SCHOOL FROBERG ELEMENTARY GREGORY ELEMENTARY GUILFORD HIGH SCHOOL HARLEM HIGH SCHOOL HARLEM MIDDLE SCHOOL HASKELL ACADEMY HILLMAN ELEMENTARY HOLY FAMILY HONONEGAH HIGH SCHOOL HONONEGAH NIGHT SCHOOL IMMANUAL LUTHERAN BELVIDERE JACKSON ELEMENTARY JEFFERSON HIGH SCHOOL JOHNSON ELEMENTARY KEITH SCHOOL KENNEDY MIDDLE SCHOOL KING GIFTED SCHOOL KINNIKINNICK SCHOOL KISHWAUKEE ELEMENTARY KISHWAUKEE ELEMENTARY LATHROP ELEMENTARY LEDGEWOOD ELEMENTARY LEWIS LEMON ACADEMY LINCOLN ELEMENTARY LINCOLN MIDDLE SCHOOL LOVES PARK ELEMENTARY LUTHER ACADEMY ALPINE LUTHER ACADEMY GLORIA DEI LUTHERAN JR/SR. HIGH MACHESNEY ELEMENTARY MANCHESTER ELEMENTARY MAPLE ELEMENTARY MARQUETTE ELEMENTARY MARSH ELEMENTARY MC INTOSH SCI & TECH MAGNET MC NAIR ELEMENTARY MEEHAN ELEMENTARY MONTESSORI LEARNING PATH MONTESSORI MAGNET MT. SINAI LEARNING ACADEMY NASHOLD ELEMENTARY NELSON ELEMENTARY NEW MILFORD ELEMENTARY NEW NON-PUBLIC SCHOOL NORTH BOONE HIGH SCHOOL NORTH BOONE MIDDLE SCHOOL NORTH BOONE UPPER ELEMENTARY OLSON PARK SCHOOL PAGE PARK SCHOOL PARKER EARLY ED CTR PECATONICA COMMUNITY M.S. PECATONICA GRADE PECATONICA HIGH SCHOOL PERRY ELEMENTARY POPLAR GROVE ELEMENTARY PRAIRIE HILL ELEMENTARY RALSTON ELEMENTARY REGIONAL ALT SCHOOL REGIONAL LEARNING ACAD REGIONAL LEARNING CENTER RIVERDAHL ELEMENTARY RIVERVIEW SCHOOL ROCK CUT ELEMENTARY ROCKFORD CHRISTIAN ELEMENTARY ROCKFORD CHRISTIAN SECONDARY ROCKFORD ENVIRON. SCI. ACAD ROCKFORD SCI/TECH ACAD ROCKTON ELEMENTARY ROLLING GREEN ROOSEVELT CENTER ROSCOE MIDDLE SCHOOL ROSECRANCE SEWARD SCHOOL SHIRLAND SCHOOL SIMON ELEMENTARY SKYVIEW CENTER SOUTH BELOIT JR HI SCHOOL SOUTH BELOIT SR HI SCHOOL SOUTH MIDDLE SCHOOL SPECTRUM SCHOOL SPRING CREEK ELEMENTARY ST. BERNADETTE ST. BRIDGET ST. EDWARD ST. JAMES ST. JAMES BELIVIDERE ST. PAUL LUTHERAN ST. PETER ST. PETER CATHEDRAL ST. RITA STEPHEN MACK MIDDLE SCHOOL STILES INVEST LEARN MAGNET STONE CREEK SCHOOL SUMMERDALE ELEMENTARY TEST THE MILL THOMPSON ELEMENTARY WALKER ELEMENTARY WALTER LAWSON CHILDREN'S HOME WASHINGTON COMMUNICATION ACADEMY WASHINGTON ELEMENTARY WEE-CARE WELSH ELEMENTARY WEST MIDDLE SCHOOL WEST VIEW ELEMENTARY WESTSIDE CHRISTIAN ACADEMY WHITE SWAN ELEMENTARY WHITEHEAD ELEMENTARY WHITMAN POST ELEMENTARY WINDSOR ELEMENTARY WINNEBAGO HIGH SCHOOL WINNEBAGO MIDDLE SCHOOL Don't see the school in the list? Please specify the name of the school and the district to which it belongs:
If this program is available district-wide, choose applicable district(s) Belvidere School District Durand School District Harlem School District Hononegah School District Kinnikinnick School District Non-Public Schools North Boone School District Pecatonica School District Regional Alternative Schools Rockford School District Rockton School District Shirland School District South Beloit School District Winnebago School District
The program is for which grades? (select all that apply) Early Education K-8 High School Higher Education
Check One: Onsite activities (at school) offsite
If offsite, please specify location:
Program Fee	Eligibility Requirements
*Please briefly describe the program:

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