2024 Community Request for Assessment Form : Assessment and Recognition Program : Get Involved : Communities of Excellence 2026

Contact Information

Name of Community

Brief Description of your Community including Geographic Area (City, County, Region, etc.):

Full Name of Individual Submitting on Behalf of your Community

Organization

Title

City

State

Phone

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Is texting okay?

What level application are you submitting?

Level 1 - Commitment to Community Excellence
Level 2 - Journey to Community Excellence
Level 3 - Community of Excellence

Terms and Conditions: Please check all that apply

I understand that we are requesting a formal assessment be conducted on our community as described above, and that this assessment will be reviewed by COE staff and volunteers.
I understand that the feedback report we receive will be shared by COE only if authorized by the person listed above.
I give COE permission to publicize the name of our community if we receive a Recognition from Communities of Excellence.
I give COE permission to share our Community Profile on the COE public website. (Visit this link for an example of how the information is displayed).

Are you a part of the National Learning Collaborative in Phase 1, 2, or 3?

If you answered yes above, you may skip the final question and click Submit.

If you answered no, the following fees apply:

Level 1: $1500: $250 payable immediately upon receipt of this form and the remainder payable when your application is submitted.
Level 2: $2500; $250 payable immediately upon receipt of this form and the remainder payable when your application is submitted.
Level 3: $5000; $250 payable immediately upon receipt of this form and the remainder payable when your application is submitted.

You will receive an invoice from Communities of Excellence 2026 within 3 days of submissions.

I am not a part of th e National Learning Collaborative Phase 1, 2, or 3 and I agree to the payment terms above associated with the Application Level I am applying for

I Agree