Org Information
Name of your organization
Name 
  Choice that best describes the type of your organization
Org Type 
  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  County the closing will be listed in when sorted by the media members.
Address1 
Address2 
City, State, Zip    
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    
 
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