2inspire Spring 2016 Registration

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* 1. Demographic information of the school registering to participate:

School District:

School: *

Address: *

Address 2:

City/Town: *

ZIP: *

Phone Number: *

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* 2. Point of contact's information for the campaign:

Name

Email

Title

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* 3. Is a specific club/organization within the school taking on this project? If yes, please specify which one below. If there is not a specific club/organization, please write N/A. If there are multiple clubs/organizations partnering on this campaign, please list them below.

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* 4. Has your school participated in a positive messaging campaign surrounding positive social norming and substance abuse prevention before?

Yes

No

Additional Information (Optional):

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* 5. On behalf of my school district, we agree to follow the campaign’s terms and conditions as follows, if selected as one of the 175 grantees:

a) My school district will receive a $500 check via regular U.S. mail addressed to our point of contact indicated on this registration form.

b) We agree that we will cash this check within 90 days of receipt and will utilize the funds to carry out the "2inspire" positive messaging campaign designed for/by youth in our school.

c) We agree that at the end of the year, we will submit sample materials our youth created.

d) We understand and agree to use funds provided for this project during the 2015-2016 academic school year.

e) If for any reason we decide not to participate in the positive messaging campaign during the 2015-2016, we agree to return the $500 check so those funds can be reinvested into the campaign.

f) We agree that our school district will complete the 2inspire pre- and post-project surveys (brief) at the start and end of this year's project.

I Agree

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* 6. If you know the nature of the project your school will be implementing or what grades will be targeted, please briefly describe it below. If you will be making this decision during the school year through discussions with your students, please indicate "to be determined".

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* 7. Briefly explain how your school plans on measuring the impact of this positive messaging campaign.