LEARNING GENIE FAMILY ENGAGEMENT DONATION.PDF
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Family Engagement Pilot Form We are offering a free three-month trial of our family engagement module. You will receive an in-kind donation for unlimited use of our software, training for administrators and staff, and customer support. The value of this donation is $1500 (training) + $8 per slot (software) at the prorated amount for 3 months. You can choose any 2-3 classes to pilot with. There is no obligation to move forward with our program after your trial has ended. Upon completion of the trial, we will conduct an exit interview to assess your progress towards your agency’s goals. Basic Information: Date of Application: May 8, 2019 Agency: Maricopa County Head Start program Pilot Point of Contact: Nancy Kessay Title: Family Services Manager Phone: 602-372-3775 Email: Nancy.Kessay@maricopa.gov Agency Address: 2150 S. Country Club Dr. #7, Mesa, AZ 85210 Program Information (circle one): Program Type: Pre-K Counts Head Start Early Head Start Private Other Desired Start Date: ___________________ May 8, 2019 Budget Cycle Start Date: _________________ July 1 Budget Cycle End Date: ________________ June 30 Technology Readiness: Please check all (if any) of the following that are available in your classroom Computer_____ √ IPAD______ √ Android Tablet____ Windows Other____ Tablet_____ If you checked “Other,” please specify: __________________________________ Is WiFi available in every classroom? (circle one) Yes No If “No,” How many classrooms have WiFi? ________ How many do NOT have WiFi?______ Fill in the total number participating: Centers: Classrooms: 3 Children: 40 Recipient Name: _______________________________ Maricopa County Head Start program Signature: ____________________________________ Learning Genie Inc | www.learning-genie.com | 760-576-4822 | 2385 Camino Vida Roble, Suite 107, Carlsbad CA 1