Thank you for your interest in partnering with Houston ISD! This application will help us get a clear picture of your interest in partnering with HISD, your organizational structure, programming and funding models. Your completed application will be reviewed and evaluated within 7 days of receipt. Potential partners will be contacted regarding next steps, if approved. If you have questions or comments, please feel free to contact us at email@example.com.
Please Note: this form can be saved at any time. You MUST confirm submission after reviewing your answers on the last page or your form will not be received.
I have reviewed the HISD Partnership Guidelines and consent to continue (
Have you reviewed the requirements for onboarding as outlined in the
Community Partnerships orientation
Are there fees associated with your service/programming?
Are you currently going through the vendor process?
Are you a mental health provider?
Are you a medical service provider?
How long have you been in business?
What client base do you serve?
What funding source do you use to see clients?
Are you on an insurance board?
Do you offer pro-bono services?
How many clinicians work with you?
What is your capacity for clients to be seen?
What is your assessment process?
What is the minimum number of students that need to be signed up before receiving services?
Contact Information and Program Overview
Primary Contact First Name:
Primary Contact Last Name
Primary Contact Email Address:
Executive Director/CEO Name:
Executive Director/CEO Email Address:
Company Street Address
Tax ID Number:
Nonprofit agency/Community based organization
State Government Agency
Federal Government Agency
City of Houston
Briefly describe your organization's mission.
Select services that apply to your organization
Out of School Time/Extended Learning Opportunities
Legal, Safety, and/or Crisis Support
Social and Recreational
If you have been working with someone from the District on this project or if you were referred by someone, please give us their name and department.
Does your organization receive federal funds?
Yes, but not in the proposed partnership
How is the programming for this proposed partnership funded?
What is the duration of this funding?
More than a year
Funding is still pending
What is the estimated value of your services?
$5,000 and above
Provide a brief description of the proposed partnership.
This partnership will be:
A one-time event
An ongoing program
An annual event
I would like my partnership to impact the following areas:
Career Readiness/Technical Education
I am interested in partnering to provide the following activities:
Basic need support
Mental Health support
Pro Bono Legal
Social emotional learning support
Out of School time
Describe your program activities (i.e. # of sessions, # of workshops).
List up to three short term outcomes expected from the program.
List up to three long term outcomes expected from the program.
Is your program limited to a zip code, area, or school?
If yes, please list the zip codes, areas, or schools.
Who is your targeted audience?
Campus Leadership (Principals, Assistant Principals, Deans, Counselors)
Campus Support Staff (Facilities, Administrative Support, Nurse)
District Support Staff (Transportation, Nutrition Services, Library Services, Wraparound Specialists, Health & Medical Wellness)
Does your program specifically target English Language Learners?
What is the maximum number of clients you are able to serve, based on either funding or staff/student ratios?
What type of school are you interested in targeting?
Early Childhood Center
A specific geographic area
A feeder pattern
How many schools are you interested in partnering with?
Is there a specific school you'd like to work with?
What specific grades would you like to target?
Proposed start date for the program.
Proposed end date for the program.
Where does your programming take place?
On-site (flexibly space on campus)
On-site (need a consistent space on campus)
Off-site (non HISD location)
Both on- and off-site
Both on-site and virtual
Do you want to request a data sharing agreement?
What do you need in place for your program to be successful?
Can you provide proof of adequate insurance?
Submit the name and contact information for two references (recipients, partners).
Upload your program logic model or program plan.
Upload your program budget (include any committed funding sources).
Upload any supporting documents you would like here.