PIE: Partner Interest Form

Contact Information

Name of Your Business/Organization *

Your Name *

Job Title *

Phone Number *

Email Address *

Will you be the main contact person for this program? *

Yes

If you answered NO, please provide contact information below for the main contact:

Main Contact Name

Main Contact's Job Title

Main Contact's Email Address

Main Contact's Phone Number

Support Details

You will receive communication for ALL types of needs, but please indicate the type of support you/your business is able to supply (check all that apply; please note that ALL school volunteers must submit to a background check): *

Financial/Direct funding	Supplies
Volunteers - Ongoing (mentoring, repeating activity, etc.)	Volunteers - Short Term (event, project, etc.)
Resources - Information, training or other services provided as a function of your business*

If you indicated that you will provide RESOURCES, please describe here: *

If you checked RESOURCES: I agree to have my contact information listed on the Midland Chamber of Commerce website for interested parties to contact me regarding my organization's ability to help with education-related resources. *

Yes

Partners in Education are made aware of the needs of ALL Midland ISD/ Midland schools. Please indicate if you would like to be put in touch with a specific campus to help them individually.

"Partners in Education" is a program of the Midland Independent School District; however, the Midland Chamber of Commerce allows for requests from all area campuses + classrooms. Please indicate your areas of interest below.

We are willing to offer support for (please check all that apply): *

Midland ISD (public schools)

Charter Schools

Private Schools

ANY School/Campus in need

Is there any other information you would like to share regarding your participation in Partners in Education?