Preschool Partnership Program ENrollment form

Director Name(s)

First Name

Last Name

Contact Email(s)

Name of Center/School

First Name

Last Name

Center or School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of children enrolled in your center/school (Diller-Quaile may use this information for grant reporting purposes)

Age range of children enrolled in your center/school

The Preschool Partnership Program is made possible by the New York State Council on the Arts with the support of the Office of the Governor and the New York State Legislature. In addition, Diller-Quaile’s Community Programs are made possible with support from The Morris and Alma Schapiro Fund, and generous donors to The Diller-Quaile Annual Fund.

Diller-Quaile is a non-profit 501(c)(3) organization that relies on contributions to its Annual Fund each year to help support its NYC Community Programs and Scholarship Fund.