Clinic Makeover Application Question Title * 1. Your Name: Question Title * 2. Email: Question Title * 3. Clinic Name: Question Title * 4. Tell us what you would like to do at your clinic to encourage reading and distribute books. Below are some examples, but please feel free to create whatever bests fits your needs. You will place an order for yourself at a later date and are NOT committing to ordering anything you see below. They are just ideas. Need more ideas? Visit https://www.lakeshorelearning.com Question Title Question Title * 5. Based on what you said above (question 4), please choose your desired funding needs. SMALL $400: We do not need a ton - just an item or two. SMALL $400: We need organizational supplies to store our new RORCO books. MEDIUM $800: We are hoping to update some of our space or several spaces in our clinic. LARGE $1,200: We would love to do a complete makeover! Question Title * 6. In order to receive funding, we are asking clinics to share one of the following with us to help us continue to build support for RORCO at your clinic and all 325+ clinics across Colorado. If you need time to gather a quote or photo, please let us know your intention to do so below. If you are ready now, just put it in the text box below. 1) Share a parent testimonial that makes the connection between receiving books and literacy guidance at your clinic and how it impacts their reading routines at home. or 2) Provide RORCO with a photo of a parent/child reading together in your clinic. RORCO will provide a photo release.or3) Ask a provider to share a quote about how providing both new books at the well visits and gently used books for kids of all ages impacts a family's ability to create positive reading routines at home. Question Title * 7. As a recipient of funding, you agree to: Share before and after photos Purchase supplies that promote books and reading together (no toys) Display RORCO partner sign in a location of your choosing (RORCO will mail this to you with a frame and Command Strips) Purchase items from Lakeshore Learning no later than June 15, 2022 Done