Org Information Name of your organization
Name
	Choice that best describes the type of your organization
Org Type	Public School/District Private/Religious School Colleges/Universities/Technical Schools Day Care/Pre-school/After School Health/Human/Social Services Business Churches/Synagogues Non-profit Government Agency
	Approximate number of people that would be affected by your organization's closing
Number affected
	Site Information Physical location of the site affected by the closing. (If the primary contact is managing this information from a location that is off-site, please uncheck the checkbox in the Contact Address section and enter a different address to be used for administrative purposes in that section)
County	Albany, NY Bennington, VT Berkshire, MA Chenango, NY Clinton, NY Columbia, NY Delaware, NY Dutchess, NY Essex, NY Fairfield, CT Franklin, NY Franklin, MA Fulton, NY Greene, NY Hamilton, NY Hampden, MA Hampshire, MA Herkimer, NY Litchfield, CT Montgomery, NY Oneida, NY Otsego, NY Rensselaer, NY Rutland, VT Saratoga, NY Schenectady, NY Schoharie, NY Ulster, NY Warren, NY Washington, NY Windham, VT Windsor, VT County the closing will be listed in when sorted by the media members.
Address1
Address2
City, State, Zip	-  CT MA NY VT
Phone	(  )
Fax	(  )
E-mail
	Primary Contact Superintendent or COO, or person normally responsible for maintaining this information and/or responsible for notification of closings/delays.
Title (Mr., Dr., etc.)
Name
Job Title
Day Phone	(  )  x
Evening Phone	(  )
Other Phone (cell, pager)	(  )
Fax	(  )
E-mail
	Contact Address If primary contact may be reached at the site address above, leave this box checked. If primary contact cannot be reached on-site, un-check this box and enter a different contact address here.
Contact Address	Same as site address if checked.
Contact Address1
Contact Address2
City, State, Zip	-  AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
	Alternate Contact If primary contact is other than Superintendent or COO, add here. If primary contact is not on-site, please add an on-site contact here. Or just add another contact.
Title (Mr., Dr., etc)
Name
Job Title
Day Phone	(  )  x
Evening Phone	(  )
Other Phone (cell, pager)	(  )
E-mail
	Notes Additional information you think the School Closings Network should know.
Notes