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1 You may print a copy of this survey in order to help you plan and select the staff for the outlined roles. Please note that all responses must still be entered into the survey and submitted in order to be recorded. * Required Information page 1 What is the Combined Charity Campaign (CCC)? Organized by Baltimore City, the Combined Charity Campaign allows city employees to donate to one of 300 local charities and agencies. Last year, City Schools staff gave from the heart to raise over $386,000 for charities serving Baltimore City. In this year s campaign, from September 17th to December 20th, we are aiming to raise $400,000. The Combined Charity Campaign is facilitated at each school by the CCC coordinator. What are the responsibilities of the Combined Charity Campaign coordinator? Publicize the campaign throughout your school Distribute and collect pledge forms Establish and implement a strategy to thank all employees for participating What are we asking you to do? We are asking each school in the District to identify a Combined Charity Campaign coordinator. If you have any questions or concerns please contact Carla Jackson (cjackson@bcps.k12.md.us). Thank you in advance! * 1. At which school do you work? (Select one option) Abbottston Elementary #50 Academy for College and Career Exploration #427 Achievement Academy at Harbor City #413 Afya Public Charter School #337 Alexander Hamilton Elementary #145 Alternative Elementary School #889 Arlington Elementary/ MIddle #234 Armistead Gardens #243 Arundel Elementary/ MIddle #164 Augusta Fells Savage Institute of Visual Arts #430 Baltimore Antioch Diploma Plus High School #366 Baltimore City College High School #480 Baltimore Civitas #343 Baltimore Community High School #367 Baltimore Design School #382 Baltimore IT Academy #378 Baltimore International Academy #335 Baltimore Leadership School for Young Women #348 Baltimore Liberation Diploma Plus High School #365 Baltimore Montessori Public Charter #336 Baltimore Montessori Public Charter Middle #383 Baltimore Polytechnic Institute #403 Baltimore School for the Arts #415 Baltimore Talent Development #428 Barclay Elementary/ MIddle #54 Bay-Brook Elementary/ Middle #124 Beechfield Elementary/ Middle #246

2 Belmont Elementary #217 Benjamin Franklin High School at Masonville Cove #239 Bluford Drew Jemison STEM Academy Middle #334 Bluford Drew Jemison STEM Academy West #364 Booker T. Washington Middle School for the Arts #130 Brehms Lane Elementary #231 Callaway Elementary #251 Calverton Elementary/ Middle #75 Calvin M. Rodwell Elementary #256 Career Academy #854 Carver Vocational-Technical High School #454 Cecil Elementary #7 Charles Carroll Barrister Elementary #34 Cherry Hill Elementary/ Middle #159 City Neighbors Charter School #326 City Neighbors Hamilton #346 City Neighbors High School #376 City Springs Elementary/ Middle #8 Claremont School #307 Coldstream Park Elementary/ Middle #31 Collington Square Elementary/ Middle #97 Commodore John Rodgers Elementary/ Middle #27 ConneXions: A Community Based Arts School Coppin Academy #432 Creative City Public Charter #384 Cross Country Elementary/ Middle #247 Curtis Bay Elementary/ Middle #207 Dallas F. Nicholas Sr. Elementary #39 Dickey Hill Elementary/ Middle #201 Digital Harbor High School #416 Dr. Bernard Harris, Sr. Elementary #250 Dr. Carter G. Woodson Elementary/ Middle #160 Dr. Martin Luther King, Jr. Elementary/ Middle #254 Dr. Nathan A. Pitts-Ashburton Elementary/ Middle #58 Dr. Rayner Browne Elementary/ Middle #25 Eager Street Academy #884 Edgecombe Circle Elementary/ Middle #62 Edgewood Elementary #67 Edmondson-Westside High School #400 Elmer A. Henderson: A Johns Hopkins Partnership School #368 Empowerment Academy #262 Eutaw_Marshburn Elementary #11 Excel Academy at Francis M. Wood High School #175 Fallstaff Elementary/ Middle #241 Federal Hill Preparatory #45 Forest Park High School #406 Fort Worthington Elementary #85 Francis Scott Key Elementary/ Middle # Franklin Square Elementary/ Middle #95 Frederick Douglass High School #450 Frederick Elementary #260 Friendship Academy of Engineering and Technology #339 Friendship Academy of Science and Technology #338 Furley Elementary #206

3 Furman L. Templeton Preparatory Academy #125 Gardenville Elementary #211 Garrett Heights Elementary/ Middle #212 George W.F. McMechen #177 George Washington Elementary #22 Gilmor Elementary #107 Glenmount Elementary/ Middle #235 Govans Elementary #213 Garceland Park/ O'Donnell Heights Elementary/ Middle #240 Green Street Academy #377 Grove Park Elementary/ Middle #224 Guilford Elementary/ Middle #214 Gwynns Falls Elementary #60 Hamilton Elementary/ Middle #236 Hampden Elementary/ Middle #55 Hampstead Hill Academy #47 Harford Heights Elementary #37 Harlem Park Elementary/ Middle #35 Hazelwood Elementary/ Middle #210 Heritage High School #425 Highlandtown Elementary/ Middle #215 Highlandtown Elementary/ Middle #237 Hilton Elementary #21 Holabird Elementary/ Middle #229 Home and Hospital #303 Independence School Local I #333 Inner Harbor East Academy #329 James McHenry Elementary/ Middle #10 James Mosher Elementary #144 John Eager Howard Elementary #61 John Ruhrah Elementary/ Middle #228 Johnston Square Elementary #16 KIPP Harmony Academy #347 KIPP Ujima Village Academy #324 KASA (Knowledge and Success Academy #342 Lakeland Elementary School #12 Lakewood Elementary #86 Langston Hughes Elementary #5 Leith Walk Elementary/ Middle #245 Liberty Elementary #64 Lockerman Bundy Elementary #261 Lois T. Murray Elementary/ Middle #313 Lyndhurst Elementary #88 Maree G. Farring Elementary/ Middle #203 Margaret Brent Elementary/ Middle #53 Maritime Industries Academy #431 Mary Ann Winterling Elementary at Bentalou #150 Mary E. Rodman Elementary #204 Matthew A. Henson Elementary #29 MD Academy of Technology and Health Sciences #331 Medfield Heights Elementary #249 Mergenthaler Vocational-Technical High #410 Middle Alternative Lombard #734

4 Midtown Academy #321 Monarch Academy Public Charter School #381 Montebello Elementary/ Middle #44 Moravia Park Elementary #105 Morrell Park Elementary/ Middle #220 Mount Royal Elementary/ Middle #66 NACA Freedom and Democracy Academy II #349 National Academy Foundation #421 New Era Academy #422 New Hope Academy #345 New Song Academy #322 North Bend Elementary/ Middle #81 Northeast Middle #49 Northwestern High #401 Northwood Appold Community Academy #330 Northwood Elementary #242 Patterson High School #405 Patterson Park Public Charter School #327 Paul Laurence Dunbar High School #414 Pimlico Elementary/ Middle #223 Reginald F. Lewis High School #419 Renaiisance Academy #433 Robert W. Coleman Elementary #142 Rognel Heights Elementary/ Middle #89 Roland Park Elementary/ Middle #233 Roots and Branches School #379 Rosemont Elementary/ Middle #63 Samuel F.B. Morse Elementary #98 Sarah M. Roach Elementary #73 Sharp-Leadenhall Elementary #314 Sinclair Lane Elementary #248 Southwest Baltimore Charter School #328 Stadium School Middle #15 Steuart Hill Academic Academy #4 Success Academy #855 Tench Tilghman Elementary/ Middle #13 The Crossroads School #323 The Green School #332 The Historic Samuel Coleridge Taylor Elementary #122 The Mount Washington School #221 The Reach! Partnership School #341 Thomas Jefferson Elementary/ Middle #232 Thomas Johnson Elementary/ Middle #84 Tunbridge Public Charter School #373 Vanguard Collegiate Middle School #374 Violetville Elementary/ Middle #226 Vivien T. Thomas Medical Arts Academy #429 W.E.B. DuBois High School #418 Walter P. Carter Elementary/ Middle #134 Waverly Elementary/ Middle #51 Western High School #407 Westport Academy #225 Westside Elementary #24 William Paca Elementary #83

5 William Pinderhughes Elementary/ Middle #28 William S. Baer School #301 Windsor Hills Elementary/ Middle #87 Wolfe Street Academy #23 Woodhome Elementary/ Middle #205 Yorkwood Elementary #219 Youth Opportunity # Who will serve as your Combined Charity Campaign (CCC) Coordinator? * (a) First Name * (b) Last Name * 3. Please provide the address of your Combined Charities Campaign Coordinator. * 4. Please provide the phone number of your Combined Charities Campaign Coordinator. If you have any questions while completing this survey, please contact Anne Lilly at alilly@bcps.k12.md.us.

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