Type of Organization *

School

Church

Community Center

Nonprofit Organization

Other

Primary Contact Name: *

First Name

Last Name

Primary Contact Phone Number *

(Please provide a phone number)

(###)

###

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What type of program are you interested in? *

(Please select all that apply)

Single-Day Pop-Up Institutes

Weeklong Camps (Spring Break/Winter Break)

After-School Programs

Microschool Partnership

Other

Preferred Time of Year for Programming *

(Please select all that apply)

Fall

Winter

Spring

Summer

I have a specific date in mind

What are the primary age groups of the students? *

Elementary (Ages 6-10)

Middle School (Ages 11-13)

Which program offerings are of interest to you? *

(Please select all that apply)

Project Power Hour (STEAM-based learning)

Mindfulness and Music

WELLpower (fitness and leadership)

Unpicky Eaters Club

Book Club

Language Exploration

Culture Exploration

Sustainable Art

Financial Literacy

Emergency Preparedness

Would you be interested in exploring cost-sharing models for program delivery? *

Yes

No

Unsure, please provide more information