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Nominators Name
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Nominators Title
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School
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Community/ school/ city
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Contact Information
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Prefered Email
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Program Hours Per Week
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Days Per Week
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Programs Run
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Community's level of engagement
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Program elements (check all that apply)
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Basic Human Needs (i.e., access to meals,
healthcare, a safe place)
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Fine Arts (i.e., drama, dance,
music, art) |
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Physical Activity (i.e.,
physical education/gym class, organized sports teams) |
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Academic Enhancement (i.e., homework
help/time, tutoring, academic enrichment classes or
clubs) |
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Social-emotional (i.e., friendship
groups, anger management classes, behavioral interventions,
counseling, life skills, mentoring, drug/alcohol use
prevention/intervention) |
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Adult Education (i.e., parenting
workshops, English as a Second Language, G.E.D. classes,
parent/child activities) |
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Community engagement |
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Other (please specify)
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Describe or list which specific elements
most impacted or engaged your community:
This success story is an example of how a community
school (check all that apply): |
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Improved community engagement in the
school |
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Improved community access to necessary
resources |
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Exposed community members to new ideas/activities |
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Provided a place and structure for
community activities (i.e., meeting space, gym space
for adult leagues) |
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Provided a safe and enriching after-school
environment for children in the community (i.e.,
those that do not attend the school) |
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Other (please specify)
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| Can you provide supporting documentation?
Please check all that apply. |
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Testimonials from community members
who participated in programs |
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Testimonials from community leaders
(i.e., businesspeople, politicians, religious leaders) |
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Event attendance records |
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Survey results (i.e., user surveys,
satisfaction surveys) |
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Photos, videos, etc. of events related
to the highlighted program |
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Other (please specify)
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What else do you want to tell us about your success
story?
Don't see a category that fits your story? Tell us
about it anyway! Email the Federation at melissa@ilcommunityschools.org
and tell us about your story, and make comments about
additions that we might make to the forms.
Thanks for your participation! When the case study
is complete, you will receive a PDF file of the finished
success story.
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