Making It Count Programs Sign-Up Form
Sign-Up for Making It Count's Programs

You may sign-up for Our Presentations by completely filling out the information below.

Please note: A minimum participation of 100 students is required in order to qualify for a presentation.

We will contact you to confirm our ability to deliver the presentation and to finalize your specific date and time.

Please check your input for any inaccuracy before clicking the submit button at the bottom of the page.

Fields denoted by an asterisk (*) are required.

 

School Contact Information

 

*Contact Name:

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Title:

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*School Name:

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*School Address:

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*City:

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*State:

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*Zip/Postal Code:

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*School Phone Number:
() -

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School Fax Number:
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*E-mail Address:

(only used for program correspondence, and will not be used for any other purpose)

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*# of total students in school:

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*Percentage of seniors going on to two or four year colleges/universities:
%

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How Did You Hear About Us: (max characters - 300)

characters left: 300

 

Program Scheduling Information

Top three (3) choices: (approximately 45 minutes in length) 1.) Date:      Time: 2.) Date:      Time: 3.) Date:      Time: # of freshmen in current class:

Top three (3) choices: (approximately 45 minutes in length) 1.) Date:      Time: 2.) Date:      Time: 3.) Date:      Time: # of juniors in current class:

Top three (3) choices: (approximately 45 minutes in length) 1.) Date:      Time: 2.) Date:      Time: 3.) Date:      Time: # of seniors in current class: