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U.S. Department of Education: Promoting Educational Excellence for all Americans

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Sample Organization Submittal Form

General Information

The form below is an example to help you fill out the EROD Organization Submittal Form. Return to EROD Collection Form.
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 ex: (123) 456-7890 x12345 or 123-456-7890 x12345
* Toll-free ex: (123) 456-7890 x12345 or 123-456-7890 x12345
Toll-free Restrictions
TTY
Fax ex: (123) 456-7890 x12345 or 123-456-7890 x12345
* E-mail Address
E-mail Address 2
WWW Address
Operating Information
Director's Name 1
Dr.
Director's Title 1
 
Director's Name 2
Dr.
Director's Title 2
 
Director's Name 3
Dr.
Director's Title 3
 
Contact's Name
Dr.
Contact's Title
 
Sponsoring Agency (Agency responsible for initiating, funding, and/or managing service, program, or organization)

Characters remaining for Sponsoring Agency Field
* 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.)

Characters remaining for Description Field
 
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)
Characters remaining for Audience(s) Field
Service(s)
Characters remaining for Service(s) Field
State(s)/ Territory(ies) Served
Characters remaining for State(s)/ Territory(ies) Served Field
Publication(s)
Characters remaining for Publication(s) Field
Subject(s)
Characters remaining for Subject(s) Field
Special Collections
Characters remaining for Special Collections Field
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.
Honorific Dr.
* First Name
* Last Name
Suffix
Title
* Phone ex: (123) 456-7890 x12345 or 123-456-7890 x12345
* Email
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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