BTS Inquiry – Bridge to Success

BTS Inquiry Form

This BTS Inquiry Form is designed to respond to specific needs identified by schools participating in the Boost Partnership, by connecting them to available community resources and services.

Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How would you like to be involved with BTS?
- Volunteer
- Internship
- Donate
- Serve on community council (indicate in comments box if you are applying to a specific seat)
- Serve on one of BTS’ CANs (indicate in comments box which CAN(s) you are interested in joining)
- Assist at one of BTS’ events
- Provide an afterschool program [Marc, can you link this answer to the RFI form]
- Other (please specify in comments box)
What is your general availability?
- Few days a week
- Once a week
- Once a month
- Occasionally
- Other
Don’t worry you don’t comment to anything by providing this information.
Which time(s) of the day matches best with your availability?
- Morning
- Afternoon
- Evening
- Weekends
Don’t worry you don’t comment to anything by providing this information.
Would you mind telling us a bit more about yourself?
What is your gender?
- Male
- Female
- Other
With which race(s)/Ethnicity(s) do you identify?
- Black/African American
- Hispanic
- White
- Middle Eastern
- Native American/Alaskan Native
- Other
(check all that apply)
What is the highest level of education you obtained?
- High school
- Some college education
- Professional training
- BA
- Graduate Degree
Do you live in Waterbury?
- Yes
- No
Do you have children in Waterbury Public School?
- Yes
- No
How did you hear about BTS?
- Referred by a friend/family member
- Referred by a colleague
- Got information at one of BTS’ events
- Internet search
- Other
Please leave any other comments you would like to share with us.
We look forward to getting back to you!