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Educational Partnerships and Family Involvement Unit

External Affairs and Outreach

Office of Communications and Outreach

U. S. Department of Education
400 Maryland Avenue, SW
Washington, DC 20202-8173

or fax to 202-260-7465.

Outreach Sign-On Form

(Note: The information you provide is subject to the Freedom of Information Act, and would be made available upon request. Please see the U.S. Department of Education's Privacy Policy http://www.ed.gov/notices/privacy/index.html for more information.)

Name of organization: ___________________________________________________________________

Address (line 1): ________________________________________________________________________

Address (line 2): ________________________________________________________________________

City: _______________________________ State: _____________________________ Zip:_____________

Area Code: ______ Telephone: __________________ Area Code: _______ Fax: _____________________

URL of organization’s education page: _______________________________________________________

Head of organization: _____________________________________________________________________

Contact name: ___________________________________________________________________________

Contact e-mail: __________________________________________________________________________

Is your organization a(n): (Please check one.)

Family-School Group Employer

Community Organization Religious Group

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OMB Number: 1860-0505 Expiration Date: 10/31/2007 According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1860-0505. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202-4651.