1. Program Title

2. Name of Bar Association

3. Address

4. City/State/Zip Code

5. Phone

6. Email Address

7. Number of Association Members

PROGRAM INFORMATION

8. Description of your program to include:

• Program's objectives
• History of program
• Number of times presented
• Targeted audience
• Number of people participating
• Measurable results of efforts to date (include statistics, program evaluation and follow-up)
• Future program plans

9. Total Program Budget

10. Source of Program Funds

11. Other Resources (e.g. inkind contributions,materials, etc.)

12. Identify other "partners" who supported your effort (e.g. bar associations, agencies, high schools/colleges/universities/law schools, law firms, etc.)

13. Note any recognition that these efforts have received (e.g. media coverage, awards, etc.)

14. Could another bar association easily replicate this program? If so, how? Are there materials, checklists, reports that lend themselves to a "how to" guide for other organizations? Please include any pertinent materials with the application form or send separately by e-mail.

15. What suggestions or recommendations would you offer to others who might undertake a similar program?

16. Program contact person, title, phone number:

17. Program contact person's snail mail and e-mail address:

Return by March 31, 2010 to:

Complete this online form. You can also email your submission as a Word document or as a PDF file to the attention of Kimberly Vann at Kimberly.Vann@americanbar.org. You can view previous award submissions online at www.abanet.org/barserv/partnership. For further information, contact Kimberly Vann, ABA Division for Bar Services, at (312) 988-5364. Thank you for your interest.