21st CCLC External Organization Profile Form

21st CCLC External Organization Profile Form
In accordance with Title IV, Part B, 21st Century Community Learning Center (21st CCLC) of the Every Student Succeeds Act (ESSA), the Georgia Department of Education (GaDOE) is required to provide a list of prescreened external organizations, as described under section 4203(a)(11). Therefore, the GaDOE is providing an opportunity for interested non-profit organizations in Georgia to submit an external organization profile.

According to federal ESSA legislation, the term “external organization” is defined as: ‘‘(A) a nonprofit organization with a record of success in running or working with before and after school (or summer recess) programs and activities; or (B) in the case of a community where there is no such organization, a nonprofit organization in the community that enters into a written agreement or partnership with an organization described in subparagraph (A) to receive mentoring and guidance in running or working with before and after school (or summer recess) programs and activities.”

For organizations interested in submitting an external organization profile, the organization must meet the minimum record of operation identified below:
- Operate a nonprofit organization located in the state of Georgia; and
- Have a minimum of five years experience operating or delivering services to out-of-school time (OST) programs or activities:
If your organization meets the record of operation and is presently in good standing with the State of Georgia, you may submit an external organization profile to the GaDOE for review.

Note:
- All external organizations that meet the criteria outlined above and complete all sections in the profile form will be included on the external organization list. The list of external organizations will be maintained on the GaDOE website for a period of two years from the posting date. After this period, if the organization wishes to remain on the list then it must reapply.
- Inclusion on this list will not constitute GaDOE approval of the quality of programs and services offered by the external organization.
- The list will be maintained by the GaDOE.
- No funding is directly associated with this profile process. This list and solicitation will not result in a contract with the GaDOE.
- The GaDOE reserves the right to remove an external organization from the list for failure of the organization to meet the conditions specified within the profile.
- The GaDOE does not guarantee any amount of work given to any provider listed on the external organization list.
- Subsequent to profile submission, all information submitted by respondents in response to the profile solicitation is considered public information, except as may be exempted from public disclosure by the Open Public Records Act.

- Contact Information -
Name of Organization*
Date of Submission*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
Email Address*
example@example.com
Website URL*
By checking the box below you are certifying that this agency is a non-profit organization in good standing with the State of Georgia*

We certify that we are a non-profit organization in good standing with the State of Georgia and not included on any state or federal debarred vendor list. Applicant must include proof of nonprofit status with the profile. (A certification letter from the IRS or FORM 990)
Browse Files
IRS Certification Letter or Form 990 Cancelof

- Experience and Expertise -
How would you describe your organization's main area of expertise?*
Please describe your organization's expertise in the following, or indicate if your organization does not provide any expertise in this particular area:
Training and Technical Assistance to out-of-school time (before school, afterschool, summer) programs*
Quality Assessments & Evaluations*
Curriculum and Resource Development*
Academic Enrichment Planning*
Coaching & Mentoring Adult Professionals*

- History -
Please identify agencies/clients that your organization has provided services for within the past three (3) years. Please include the name of the agency as well as contact information for the main point of contact (email address, phone number).
Any additional comments?
Should be Empty: