Please complete this membership form for individual members. We welcome your participation! Any and all information provided will not be shared with any others -- your information will be treated confidentially. Thanks!

Name
Title
Organization
Address
City
State
Zip
Phone
Fax
Email
Your School/ Community
Work you are doing at the school

Do you have contacts with your local media?
	yes no

Do you, or your organization, have contact with policy makers
	yes no
If yes, who?

Does your organization have a membership base that it might be willing to activate to promote policies regarding community schools?
	yes no

The federation has two types of membership: Stakeholder Members and General Members. Stakeholder Members are individuals who are actively engaged in the work or bringing together community and school to enhance the educational opportunities of students while strenghening families and their communities. General Members are individuals who are committed to the mission of the Federation. Please indicate which member type you are:
Stakeholder Member
General Member

What type of assistance are you looking for from the Federation?

Federation for Community Schools ▪ 20 N. Wacker Drive ▪ Suite 1741 ▪ Chicago, Illinois ▪ 60606 ▪ Phone: 312.629.4990 ▪ Fax: 312.629.4999

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