Maine Adult Education Directory - FY10

Information Survey

This survey will provide the information needed to publish this year's Maine Adult Education System Directory. Please fill in the requested information as completely and accurately as possible. If a particular field does not apply to your program, leave it blank (do not enter N/A or any other notation). Once you have filled out the form completely click on the "Submit" button at the bottom of the page. Remember that the information will be published exactly as you have entered it, so please double check the accuracy of the information before submitting the survey.

SAU Information

SAU Name:

Superintendent:

Program Information

Adult Education Program Name:

Office Address 1:

Office Address 2:

City:

Zip:

Office Telephone#:

Office Fax #:

Adult Education Website Address:

Learning Center Information

Learning Center Address 1:

Learning Center Address 2:

City:

Zip:

Learning Center Telephone #:

Learning Center Fax #:

Personnel Information

Director's Name:

Director's Email Address:

Co-Director Assistant
Name:

Assistant Director's Email Address:

AEFLA Coordinator's Name:

AEFLA Coordinator's Email Address:

GED Chief Examiner's Name:

GED Chief Examiner's Email Address:

MAEMIS Primary Data Entry Person's Name:

MAEMIS Data Entry Person's Email Address:

Communities Served: (Please list communities separating each by a comma) Note that due to limited space in the directory, most listings will be limited to 6 - 8 communities. Any additional communities will be covered using the phrase "and surrounding communities." Therefore, please make sure that the first communities you list are the ones you most want the public to see.

Name of Person Filling out this Survey:

New Data - This is the first time this year I have submitted this data
Revised Data - I had submitted our data previously, but need to make corrections (Please resubmit all data if making revisions/corrections)

(Please click the Submit button only once)

The Adult Education Director will receive an email (at the Director's email address entered above) confirming receipt of the data