Application for PGC-HS Certification

PGC-HS Certification Application Form
Please complete the following form to apply for Peer Group Connection (PGC) certification for your school. If approved, you will be sent certificates for your school site, eligible stakeholder team members, and eligible peer leaders. If we do not receive your application by Friday, May 12th, we cannot guarantee you will receive your certificates prior to the end of the school year.
School Name*
Faculty Advisor Names*
Stakeholder Team Coordinator Name*
PGC Certification Application Contact Person*
First NameLast Name
PGC Certification Application Contact E-mail*
Your application for PGC certification has the following requirements. Please indicate whether you have completed or will complete the following prior to May 30th.*
Completion of the Impact Tracking Tool (ITT)Completion of a sustainability plan for next school year (in the ITT)Completion and submission of End-of-Year surveys for peer leaders to CSSCompletion and submission of End-of-Year surveys for freshman outreach participants to CSS
Please share why your school would like to become a Peer Group Connection (PGC) certified site.*
In what ways has PGC had or in what ways do you anticipate it will have an impact on your school community?*
Administrator Signature
My electronic signature below indicates that my school has my support in participating in the PGC Certification Process. I have reviewed the PGC Program Certification documents and am aware of all that’s required for my school to become a Certified Program Site. Should our school be selected to participate in the certification process, I give permission for the CSS (Center for Supportive Schools) staff to conduct the necessary program assessments. These assessments will include observing the PGC course, outreach workshops, and collecting data and other information from the PGC stakeholder team in our building. I also understand that participating in the certification process does not ensure that my school will receive PGC certification and that we will be notified in writing of our certification status. Please type your name below to electronically sign this document. *

PGC-HS Certification Application Form

Administrator Signature

Peer Leader Nomination Form for PGC-HS Certification