YOUR CONTACT INFORMATION

First Name:

Last Name:

Pronouns:

Preferred Pronoun: (if not listed)

What is your title/role?

Work Email:

Phone Number:

e.g. 773-312-3989

SCHOOL/ORGANIZATION INFORMATION

Name of School/Organization/Company:

Address:

City:

State:

Zip code:

School/Company/Organization Website URL: (if available)

INTEREST IN NEWROOT

What is your interest with NewRoot?

Partnership support for my school/organizationProfessional learning for myselfProviding services to NewRootOther

How did you hear about NewRoot?

Other (please specify below):

Which NewRoot Team Member/Staff referred you:

YOUR SCHOOL'S CULTURE & CLIMATE

	Not at all	Slightly connected	Somewhat connected	Quite connected	Extremely connected
How connected do you think students feel with their teachers/staff/other adults at your school?

	Not at all effective	Slightly effective	Somewhat effective	Quite effective	Extremely effective
How effective has your school been in encouraging and advancing student & school-wide equity?

1) What current systems & structures are working?

2) What current systems & structures are NOT working?

YOUR ORGANIZATION'S CULTURE

	Not at all	Slightly connected	Somewhat connected	Quite connected	Extremely connected
How connected do people (e.g. youth + staff, colleagues, etc.) feel with each other at your organization?

	Not at all effective	Slightly effective	Somewhat effective	Quite effective	Extremely effective
How effective has your organization been in encouraging and advancing equity?

1) What current systems & structures are working?

2) What current systems & structures are NOT working?

NEWROOT FOLLOW-UP REQUEST

Please briefly tell us how we can support you:

INDIVIDUAL PROFESSIONAL LEARNING & DEVELOPMENT

May we follow up regarding upcoming workshops, professional development opportunities & other NewRoot news and resources?

Yes, please!No, thank you.

INTERESTED IN BECOMING A POTENTIAL NEWROOT SUPPLIER/VENDOR?

Please provide a brief description of the specific service(s) your business/organization provides?

Since NewRoot is a small non-profit with limited budget, would your business/organization be interested in donating its services or providing services at a discounted/non-profit rate?

YesNo

To ensure businesses/organizations we work with align with our mission & values, NewRoot prefers to work with eco-friendly/sustainable, fair trade & equity-focused organizations (e.g. minority-owned). Would you describe your business or organization as such?

YesNoNot sure

In a brief sentence, describe how your business/organization might align with our mission or values? (Optional)

NEWROOT COMMUNICATIONS

Would you like to receive our monthly newsletter to stay updated on NewRoot's events, receive free digital downloads, and join a community of change-makers?

Yes please sign me up!No, thank you.

Thank you again for your interest in NewRoot!

We are actively working to accommodate current partner requests & will try to get back to you within 3-5 business days. Please note:

Initial intake meetings are scheduled based on availability
Quotes and/or proposals are provided AFTER the initial intake meeting to ensure we have a solid understanding of your organizational needs
30-day advance notice is required for scheduling any professional workshops/events
For urgent requests, please contact us at partnerships@newroot.org

Thank you again for your interest in NewRoot!

We are actively working to accommodate current partner requests & will try to get back to you within 3-5 business days.