Organziation:

Name:

Address:

City:

State:

Zip:

Phone:

FAX:

Email:

Type of Organization:

1. Please state the mission of your organization.

2. How is your organization involved in civic eduacation?

3. Please indicated populations served.

4. What are the results/outcomes of your civic education activites?

5. What future initiatives are planned related to Civic Education?

6. What support do you have (grassroots, political, financial, etc.)?

7. Is what you are doing being publicizied? If so,how?

8. Would you be interested in participating in a coalition to support civic education and civic renewal in Florida: