Registration – National Charter Collaborative

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Full Name

Work Email Address

Executive Assistant Email Address

Cell Phone Number

Enter Your Date of Birth

Tell us a little about yourself. Include your professional background and current position.

Please upload a professional headshot.

What racial group do you primarily identify as?

BlackLatinoAsianNative AmericanMiddle Eastern/North AfricanPacific IslanderCaucasianOther

What is your current title or role in your field?

If you are a school leader, are you the founder?

YesNo

Are you currently a leader of a single-site charter school or small network of 3-5 schools?

Yes, I'm a leader of a single-site charter schoolYes, I'm the leader of a small network of 3-5 charter schools

If you are a school leader, how many years have you been at your school?

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