My Hometown Community-School-Business Data Form

Introduction:

Student-centered digital photography and research projects will bring to life the essence of living, learning, and working in hometowns throughout the United States.

This "My Hometown" web-based data gathering form will guide students and their advisors through their research process. The development guide will provide writing prompts and file names for digital photos available for transfer to TheCenter4.com.

We appreciate your interest in presenting your community and its uniqueness through the "My Hometown" section of TheCente4.com.

If you need assistance, call us at 207 623 3076 or e-mail us at info@thecenter4.com.

Note: For each personal career profile, you will need to submit a Personal Career Profile Data Gathering Form for each selected worker. The link for this form can be located by clicking your browser's back button. Be sure to do all your original research in a word processing program and then copy and paste the necessary information into this form.

Directions: Complete all items!

Please complete each item. Your contact information will help us serve you better.

Advisor's Last Name:
Advisor's First Name:
Advisor's Title:
Organization:
Address Line 1:
Address Line 2:
City:
State:
Zip Code:
Type of Organization:
Number of Research Team Members:
Voice Telephone (xxx-xxx-xxxx):
FAX (xxx-xxx-xxxx):
Advisor's E-mail Address:
Organization's Internet Address:

Complete all requested items that describe your town.

Name of Town:
State:
Year Founded:
Current Population:
Number of Schools:
Number of Businesses:
Town's Internet Address:
Town's E-mail Address:
Voice Telephone:
Name of Chamber of Commerce:
Telephone Number:
Chamber's E-mail Address:
Chamber's Internet Address:

Please provide an up-to-date narrative profile of your town.

Please enter the URL address for transferring a picture to TheCenter4 that best represents your town.

Town Picture Transfer Address:

Please provide an up-to-date narrative profile of your school.

Please enter the URL address for transferring a picture to TheCenter4 that best represents your school.

School Picture Transfer Address:

Enter up to ten businesses that you wish to present in the "My Hometown" section of TheCenter4.com.

Business # 1:
Business # 2:
Business # 3:
Business # 4:
Business # 5:
Business # 6:
Business # 7:
Business # 8:
Business # 9:
Business # 10:

Enter job titles for each business that you identified in the previous question. In this question, you are asked to identify the job titles of the workers you will be profiling in the "My Hometown" section of TheCenter4.com. The idea is to include different types of businesses and a different type of worker in each business. For example, if you had two insurance agencies in your business profiles, you would not feature an insurance agent in each profile. In one profile you would feature an insurance agent. In the second profile, you might feature an administrative assistant to the agent.

Job Title -- Business #1:
Job Title -- Business # 2:
Job Title -- Business # 3:
Job Title -- Business # 4:
Job Title -- Business # 5:
Job Title -- Business # 6:
Job Title -- Business # 7:
Job Title -- Business # 8:
Job Title -- Business # 9:
Job Title -- Business # 10:

Thank you for taking the time to complete this data collection form. Select Submit This Form now to send your responses to us.