Todays Date Todays Date

Name of Adopter (Business or Organization)

Name of Adopter Coordinator

Email of Adopter Coordinator

Phone number of Adopter Coordinator

Adopter's preferred method(s) of contact Adopter's preferred method(s) of contact Email Phone Call Mail

City Address of Adopter Business or Organization

State Address of Adopter Business or Organization

Zip

Name of School(s) to be Adopted

Services you can provide Services you can provide Financial donation Donation of school supplies Sponsoring/hosting staff lunch Volunteering for events Hosting job fairs Greeting students before school Lawn care/general maintenance of grounds Organizing student of the month program Organizing teacher of the month program Serving on a committee Other

If other explain

Would you be willing to be matched with a school that requires your specific provided services? Would you be willing to be matched with a school that requires your specific provided services? Yes No