ABOUT EPP

EDUCATIONAL PRIORITIES PANEL
MEMBERSHIP APPLICATION

Full Name of Agency: ___________________________________________________________

Address: ________________________________________ Zip _________________________

Day Phone: ___________________________

Executive Director/ President (Chief Operating Officer): __________________________________

Contact Person: ____________________________________Day Phone __________________

The following questions will help us get to know your agency and your work in education. Please add any brochures or publications that you think would be useful to us. Feel free to use more space as needed. Please attach a list of members of your board of directors with organizational or business affiliations listed and a copy of your current bylaws.

1. Give us a brief description of your agency, including general goals, general activities, issues of concern, membership, constituency, clients, and types of funding:

2. When was your organization founded?_______________

3. What is the geographic scope of your agency? ___ City wide ___Borough wide ___ Other. Please explain:

4. Describe your agency's process for determining policy positions, including the approximate time needed for reviewing and adopting a policy (i.e., review at monthly meetings, discretion of executive director, etc.):

5. List all of your activities and positions that relate to education (services provided, research projects, policy positions, etc.):

6. Do any members of the Board of Directors or does the organization receive funding from the New York City Board of Education? Please list the names and officer titles of members of the Board of Directors receiving these funds and specify whether employee, consultant, or grantee. If the organization receives these funds, specify the reason(s) and the amount(s):

7. Does your education agenda include work with non-public schools? If yes, please describe:

8. What benefits does your agency hope to receive as a member of the Panel?

9. What can your agency contribute to the Panel?

10. What expertise or focus can your agency bring to the Panel?:

11. Have the members of your Board of Directors read the Panel's policy positions? Is there general agreement with these positions? Describe briefly any comments or differing opinions:

12. Panel members are asked to make a voluntary annual contribution to the Panel to help defray the expenses of the Chairperson and the mailing costs. What level of support, if any, will your organization contribute each year? ___$50 ___$100 ___$260 ___$500 ___$1,000___ Other: $___

13. Who will attend the weekly Panel meetings? How has this person been chosen and what is this representative's organizational position (i.e., board member, volunteer, staff)?

Thank you for filling out this questionnaire. Your application for membership will be reviewed by the Panel at a regularly scheduled coalition meeting, after first having been reviewed by the Executive Committee. After a Panel vote to accept a new organization for membership, EPP staff will notify the organization and request a letter from the organization signed by the highest official formally accepting membership and designating the organizational representative who will regularly attend meetings and vote on behalf of the organization.

This form should be sent to: Noreen Connell/ Executive Director/ Educational Priorities Panel/ 225 Broadway/ 39th Floor/ New York, NY 10007. If there are any questions regarding this application, please call the EPP office at (212) 964-7347.