If you are requesting programs for multiple schools, please submit a separate form for each school. 

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* 1. Your name

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* 2. School 

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* 3. Your role (guidance counselor, principal, teacher, etc.)

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* 4. Phone number

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* 5. E-mail address

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* 6. How many classrooms of each grade would you like to schedule?
Note: We present to each classroom individually and will schedule as many sessions as possible on each day.

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* 7. Is there a particular time of year, month, week, or day(s) of the week  that you are hoping to schedule these programs? If so, please describe.

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* 8. Can you briefly tell us how you hope your students will benefit from our programs?

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* 9. Are there any dynamics or issues related to inclusion within a classroom, a grade, or the school's students in general that you would like us to be aware of? If so, please describe.

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* 10. Do you have questions at this point or is there any other info you would like to share with us?

Thanks for requesting our programs! We will be in touch shortly.

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