Program Partner Certification Form

Name of Organization(Required)

Year Founded(Required)

Organization Website

Contact Name(Required)

Contact Title

Contact Email(Required)

Contact Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Is your organization Charleston County based?

Yes

No

Describe the organization’s mission especially as it applies to education outreach.(Required)

List three recent educational programs your organization has delivered.(Required)

Include name of school, contact at school and year of program.

Attach Verification of Tax-Exempt Status(Required)

Max. file size: 32 MB.

(IRS determination letter)

This field is for validation purposes and should be left unchanged.