EmailMeForm
2024-2025 Community Partner App:
Thank you for your interest in becoming a Community Partner for Pacific Charter Institute and its family of schools: Heritage Peak Charter School, Rio Valley Charter School, Valley View Charter Prep, Sutter Peak Charter Academy, and New Pacific Schools, Roseville and Rancho Cordova. Please complete all sections of this request form for consideration to become a PCI Community Partner.
NOTE: Please proofread your responses/answers as they
will not
be automatically corrected.
1
Prospective Partner Information
2
Acknowledgement Agreement
3
Additional Business Information
4
Service Information
5
Additional Business Details
6
Liability Insurance
7
Protocols, Invoice Requirements, Agreement
▶
1
Prospective Partner Information
2
Acknowledgement Agreement
3
Additional Business Information
4
Service Information
5
Additional Business Details
6
Liability Insurance
7
Protocols, Invoice Requirements, Agreement
Prospective Partner Information
Business Name
*
The Business Name will be used as the listing on the public listing of the Community Partner List upon application approval.
Business Address
*
City
*
This will be listed on the public listing of the Community Partner List upon application approval.
State
*
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
This will be listed on the public listing of the Community Partner List upon application approval.
Zip Code
*
County
*
COUNTY the business is physically located. This will be listed on the Community Partner List upon application approval. If no physical location, the COUNTY of the location listed on your liability insurance may be used for this listing.
Phone Number
*
###
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###
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####
This will be listed on the Community Partner List upon application approval.
Fax
###
-
###
-
####
This will be listed on the Community Partner List upon application approval.
Business Email
*
This will be listed on the Community Partner List as the email where Purchase Orders will be sent upon application approval.
Website
This will be listed on the Community Partner List upon application approval.
Length of Time in Business (years)
*
Enter Number in Years. Round to two decimal places.
Examples:
1 month = 0.08
3 months = 0.25
6 months = 0.50
9 months = 0.75
1 year = 1.00
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