CoBro Consulting Program Information Form

Please complete one form for each program for which CoBro provides services.

Information provided in this document will provide us with a better understanding of your program, and help ensure we are aligning our data collection and/or evaluation services to your particular needs.

I. Contact Information

Program Director/Manager contact information:

Additional contact, if applicable:

II. General Information

In the table below, please enter the school year for each year of your program at the beginning of the designated row. Next, add the number of students you will serve in each of those years (by grade level) in the subsequent columns. If no students are served in a grade level during a specific year, please leave the field blank.

School Year 1:

------------------ Number of students served in each grade level -----------------

School Year 2:

School Year 3:

School Year 4:

School Year 5:

School Year 6:

School Year 7:

Please describe any additional program features you feel are unique to your grant.

Thank you for providing this additional program information.

If you have any questions, please contact Darlene Cole at dcole@cobroconsulting.com

Your Program Information Form has been submitted. We will be in contact soon.