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WhatWorksSC Clearinghouse Application

Please complete the application form as completely as possible.
If you do not have a response for a field, please type NA in the box.
 

Name of Program/Initiative:
Goal (one sentence goal):
Short Summary:
   
 Demographics  
   
Target Settings (urban, suburban, and/or rural):
 Target Groups Served:  
 Schools/Districts Served:  
   
Research and Evaluation  
 Research:

What national or other research was considered during the development of this program?

 Evaluation:

Describe the evidence that shows that the program/initiative works.  Description of data collection and analysis should be included.

Program Resources  
   
 Annual Cost:  
Funding Sources:  
Staffing Needs:  
Infrastructure/Equipment Needs:  
Partner Organizations:  
   
 Contact Information  
 Name:
Title:
Organization:

Telephone
(please include
the area code):

Email:
Website:
Links to other information (i.e., news article, video, etc.)