Please complete the following information to begin the application process or download a PDF of the application here.

Required information is shown in boldfaced type and is preceded by an asterisk (*). All other information is optional. Our Privacy Policy Statement is available for your review.

*Salutation	Please Select Ms. Mrs. Miss Mr. Dr. Sister Father Brother Rabbi Rev. Prof. Monsignor Capt. Lt. Major Sgt.
*First Name
*Last Name
Program Name
*Organization
*Address
Address Line 2
*City
*State	Select State AA - Other Americas AE - Military Facilities AK - Alaska AL - Alabama AP - Intl Mail - Pacific AR - Arkansas AS - America Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Isl MI - Michigan MN - Minnesota MO - Missouri MP - Marianas Isl MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming
*Zip
*Phone Number (including area code)
Fax Number (including area code)
Website address
*E-mail Address (e.g., teacher@aol.com)
*E-mail Address again as confirmation
*Is this your home e-mail address or your work e-mail address?	Home Work
*How did you hear about Scholastic Literacy Partners? (Check all that apply)	Scholastic Representative Internet Conference Mailing Another Literacy Partner Magazine Other
Please provide a detailed description of your organization, its mission and literacy efforts.
What is the primary focus of your organization?	Reading/Education Health Services Child Care Community Service Shelter Library Tutoring/Mentoring Literacy Coalition / Council Resource Center Other
Is your program affiliated with a national organization (Check only one)	Even Start Head Start HIPPY Motheread Parent-Child Home Program Parents As Teachers Reach Out and Read Reading Is Fundamental Stand for Children Success by Six Other
*How many children does your program serve?
*What are the ages/grades of the children? (Check all that apply)	Birth-4 K-3 (Ages 5-8) 4-6 (Ages 9-11) 7-9 (Ages 12-14) 10-12 (Ages 15-19)
What percentage of the children in this program are	Caucasian Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Asian American Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Hispanic Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Native American Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% African American Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pacific Islander Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Other Please select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Please check the first language spoken in the homes of the children you serve (Check all that apply):	English Spanish Chinese-Mandarin Chinese-Cantonese Cambodian Korean Portuguese Vietnamese Russian French Arabic Haitian/Creole Other
How would you describe your program's literacy activities (Check all that apply):	Tutoring Family Literacy Parent Education Early Childhood Literacy ESL Adult Literacy Professional Development Home Visits Other
*Describe how books are used in your program.
*What is the estimated number of books your program purchases each year?
Please identify your program's funding sources and how long these funds will be available.	Funding Source Availability Funding Source Availability
Where do you purchase your books currently?	Bookstore Wholesaler Publisher Other
Please provide the names of the resources you rely on to stay informed about literacy products, funding and other literacy news. (Check all that apply)	Catalogs Trade magazines Newsletters Conferences Web sites Other