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I am the*
Principal
Assistant Principal
Dean
Afterschool Director
Program Director
Managing Director of Operations
Director of Operations
Operations Manager
Community School Director
Parent Coordinator
Admin Personnel
PTA
Head Coach
Assistant Coach
Athletic Director
Assistant Athletic Director
PE Teacher
First Name*
Last Name*
Phone*
Email*
In what location will PEP take place?*
Gymnasium
Outdoor Facility
Multi-Purpose Room or Area
1 or more of the above
Any Alternative Space?*
Type of Enrichment Program Interested In*
Basketball FUNdamentals
Active Kids 60
Multi-Sports, Games & Activities
Soccer FUNdamentals
Enrichment Program Interested In*
Mornings
Recess
Gym
Afterschool
Weekends
Holiday Camps
Summer Camps
Does your school or organization follow the DOE Holiday Schedule?*
Yes
No
School Type *
Elementary
Middle School
Junior High School
General Center
Input All Grade Levels To Service*
Any IEP participants?*
Yes
No
School *
Address*
City *
State/Province*
Zip/Postal Code*
3 weeks are required prior to start date of proposal agreement *
Overall Anticipated Number of Participants to be Serviced per Hour?*
<30
30
45
60
75
90
105
120
135
150
150+
Overall number of participants to be serviced in the program?*
<30
30
45
60
75
90
105
120
135
150
150+
Anticipated Start Date & Time (Minimum Engagement 2+ Months) Start time must be 2+ hours before end time*
Anticipated Start Date & Time (Minimum Engagement 2+ Months) Start time must be 2+ hours before end time*
Anticipated End Date & Time (Minimum Engagement 2+ Months) End time must be 2+ hours after start time*
Anticipated End Date & Time (Minimum Engagement 2+ Months) End time must be 2+ hours after start time*
Anticipated Hours Per Day*
2 (Minimum)
3
4
5
6
7
Budget for Implementation of PEP School Hours? (2+ Months)*
1-Day Per Week- $10k-$25k+
2-Days Per Week- $20k-$35k+
3-Days Per Week- $30k-$45k+
4-Days Per Week- $40k-$55k+
5-Days Per Week- $50k-$65k+
6-Days Per Week-$60k-$75k+
Interested In Holiday or Summer Hours
Budget for Implementation of PEP Holiday or Summer Hours?*
1-Week Camp- $5k-$10k+
2-Weeks Camp- $10k-$15k+
3-Weeks Camp- $15k-$20k+
4-Weeks Camp- $20k-$25k+
5-Weeks Camp- $25k-$30k+
6-Weeks Camp- $30k-$35k+
7-Weeks Camp- $35k-$40k+
8-Weeks Camp- $40k-$45k+
9-Weeks Camp- $45k-$50k+
10-Weeks Camp- $55k-$60k+
Interested In School Hours
Enrichment Days Interested? (Must Match Anticipated Budget & Start Date)*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
PEP Additional Comments *
SUBMIT