Leadership Council Member

Information Form

Name: ____________________________________________________________________________________

Address: _________________________________________________________________Zip______________

Phone: (Home):________________________________ (Work):_________________________________

(Cell):_________________________________

e-mail address: ____________________________________________________________________________

Name of Business/ Organization: ________________________________________________________

Title: ______________________________________________________________________________________

Interest or Motivation with Early Childhood Initiatives:

Other Active Community Involvement:

Any Questions/Comments:

Vision: A diverse community where every family is supported and has access to quality programs and resources for their young child.

Mission: To help all children enter school healthy and prepared to succeed.