Please fill out the following form, and your participation will be noted on the Attendance Action Map.

**Please note: Your entry will not show up on the map immediately. All entries need to be approved before posting. We will post them within 24 hours.
SCHOOL/ORGANIZATION INFORMATION
School/Organization Name: *

Address *

Contact Name *
First Name Last Name
Contact Email Address: *
Contact Phone: *
- Area Code Phone Number
Organization Website:
*Be sure to include the http:// in your URL.
It is usually best to copy and paste your URL from a browser, to ensure accuracy.
Organization/Event Facebook Page:
*Be sure to include the http:// in your URL.
It is usually best to copy and paste your URL from a browser, to ensure accuracy.
Twitter Username:
Does your effort contain a mentoring component? *

Yes No
Is a local United Way involved with your effort? *

Yes No
Is your effort connected to a local Campaign for Grade Level Reading? *

Yes No
WHAT YOU’RE DOING
We're celebrating attendance awareness month by... *

mobilizing a community coalition. integrating attendance messaging into back-to-school events. organizing a back-to-school door knocking effort. hosting community events. issuing a proclamation. displaying an attendance exhibit. holding a house party. creating a community toolkit. running PSAs. launching a poster or video contest. honoring attendance champions. establishing or expanding programmatic interventions (for example, a local success mentor initiative)
If your activity includes an event, please include:
Event Name:
Event Location Name:

Event Address

Event Start Date/Time:
- Month - Day Year
at
: Hour Minutes
Event End Date/Time:
- Month - Day Year
at
: Hour Minutes
Grade Levels Served:
Short Description of Event:

Please limit your entry to 1,000 characters or less. 0/1000
Should be Empty: