CMSD Student Quality Service Documentation Form

CMSD Student Quality Service Documentation Form

Thank you for taking the time to complete the Student Quality Service (SQS) form. This document helps us better understand your programs, which students you are servicing, and how your program is being evaluated.

The SQS form is the first step of the CMSD Community Partnership Protocols, it is required prior to work beginning with a school and will be sent out annually to make necessary updates. The information you provide allows school teams to make informed decision to ensure programs align with district priorities. The SQS process informs the District of the schools you will be working with.

Partnerships are vital to enriching our scholars’ academic experiences and providing personal and professional support. CMSD values the many collaborative partnerships with community organizations, government, and the business sector that support student success.

ORGANIZATION INFORMATION

Organization*

Date*

Did you complete this form last school year?

Select

Website*

Phone Number*

Street Address*

City*

State*

Zip Code*

Executive Director Name*

Executive Director E-mail*

PROGRAM POINT OF CONTACT

Primary Program Contact Name and Title*

E-mail (Program Contact)*

Phone Number*

PROPOSED PROGRAM/SERVICE OVERVIEW

Please indicate the programs that you will no longer have available.*

Please provide the name(s) of the program(s) and/or service(s) you will be providing to CMSD schools*

What grade levels do the program(s) and service(s) serve?*

Select all that apply

Select

What neighborhood(s) do you typically serve?*

Select all that apply

Select

Please indicate other neighborhoods that you serve:

Schools served in the prior school year

Please select all schools receiving your programming/services either in person or virtually.

Select

Which K-8 school buildings do you plan to work with in the upcoming school year?*

Select

Which High School buildings do you plan to work with in the upcoming school year?*

Select

What type of programming are you providing?*

Virtual

In Person

Faith Based

If you are providing in person programming please share where that program is taking place.*

Select

If you answered other to the previous question, please describe.*

Time frame for services*

Select all that apply

Select

If other time frame, please specify*

What is the cost of the program?

Service/Program funding source

Select

If funding has been secured please share the funding amount, if possible.

CMSD Goals Addressed

Please choose all that apply

What areas does your program focus on?*

Select

Please specify "other" for focus areas*

Do you have an evaluation process in place for your program?*

Select

Please provide confirmation that BCI/FBI checks have been completed for the staff providing programming.

All providers who are working with CMSD scholars (virtually or in person) must have a BCI/FBI background check. Please provide the names and background check dates for all paid school based staff. If volunteers are assisting with programming, you must register them separately with the C.M.S.D. Volunteer Office.

Background check dates should not be older than one year at the time of application. All security checks must be cleared of felonies.

Your organization must have on file current security checks in the event you are asked to provide copies to CMSD.

If your staff has not completed an FBI/BCI check, they can be done through CMSD's Safety and Security office at the East Professional Center, 1349 East 79th Street. The link below will provide days, times, cost etc. https://www.clevelandmetroschools.org/Page/536

If you choose to use CSMD for this process, please provide explicit instructions to the Safety and Security office staff so the completed check can be sent to you.

Have background checks (BCI/FBI) been completed for the staff or third-party service providers??*

Select or enter value

Do you have updates regarding your volunteers (unpaid staff)?*

Select

Do you understand that all staff and volunteer security checks must be clear of felonies?*

Select

Will your services be provided by volunteers?*

If yes, please refer to http://www.clevelandmetroschools.org/Page/537 and follow the requirements under "Volunteer Registration for Community Partners and their members" section of the page.

Yes

Have volunteer background checks been completed?

Select

Please provide two references from organizations or schools you have served.*

Include contact name, organization/school, email, and phone number. If you have been working with staff of CMSD, you can include them as a reference.

File Attachments

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