EROD New respondents to the Online Form

EROD OnlineForm New Submittal.txt Date: 1/24/2007

New Organization Submittal Form

General Information

Use this form to suggest your organization for addition in the
Education Resource Organizations Directory (EROD). To find out
if your organization qualifies to be in the Directory, please
read our "Criteria for Inclusion" statement. If the
information you submit is added to EROD, it will be available
to the public at http://www.ed.gov/Programs/EROD/.

You don't have to provide information for every item on this
collection form, but items with an asterisk (*) are required.
If you have any questions, please contact us at
mailto:[email protected], or check out our sample form.

OMB # 1800-0012

Location Information

* Service, Program, or Organization Name
* Address 1
Address 2
Address 3
* City
* State
* Zip

Contact Information

Please input either the phone number or the toll free number,
or both.

* Phone e.g.: (123) 456-7890 x123
* Toll-free
Toll-free Restrictions
TTY
Fax
* E-mail Address
E-mail Address 2
WWW Address

Operating Information

Director's Name 1 Honorific First Middle Last Suffix
Director's Title 1

Director's Name 2 Honorific First Middle Last Suffix
Director's Title 2

Director's Name 3 Honorific First Middle Last Suffix
Director's Title 3

Contact's Name First Last
Contact's Title

Sponsoring Agency (Agency responsible for initiating, funding,
and/or managing service, program, or organization)

* Description (Includes the mission and/or goal(s) of the
service, program, or organization. Please describe the program
in a clear and "friendly" manner for the general public.)

Days & Hours of Operation e.g., M-F 9:00 a.m.-5:00 p.m.

Time Zone

Indexing Information

To view a list of terms for a category, select the category
name link at the left (Audiences, Services, etc.).

Audience(s)

Service(s)

State(s)/ Territory(ies) Served

Publication(s)

Subject(s)

Special Collections

Submitter Information

Submitter must provide all required fields below for the
purpose of validation. The email that you provide below will
be the one that will receive the email confirmation.

* First Name
* Last Name
Title
Phone
* Email

Comments (Optional)

Please provide any additional comments/suggestions about this information collection form, the directory, or EROD website.

According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless
it displays a valid OMB control number. The valid OMB control
number of this information collection is 1800-0012. The time
required to complete this information collection is estimated
to average 1 hour per response for a new submission or 10
minutes per response for an update or correction, including
the time to review instructions, search existing data sources,
gather the data needed, and complete and review the
information collection. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving
this form, please write to: U.S. Department of Education,
Washington, D.C. 20202-4651. If you have any comments or
concerns regarding the status of your individual submission of
this form, write directly to: U.S. Department of Education,
Office of the Chief Information Officer, Development Services
Group, Attn: EROD, 400 Maryland Avenue, S.W., Washington, D.C.
20202-4760.

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