var giftType = "One-time";
Virtual Outreach Program Request
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1.
Question - Required -
Your First and Last Name:
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2.
Question - Required -
Your Email Address:
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3.
Question - Required -
Your Phone Number:
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4.
Question - Required -
School Name:
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5.
Question - Required -
Is your school Title 1?
Please select response
Yes
No
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6.
Question - Required -
Grade Level:
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7.
Question - Required -
Students per Class:
8.
Question - Not Required -
If you would like to schedule for your entire grade, how many classes are in your grade level?
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9.
Question - Required -
Preferred Month(s):
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10.
Question - Required -
Preferred Day(s) of the Week:
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11.
Question - Required -
Preferred Start Time:
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12.
Question - Required -
School District:
13.
Question - Not Required -
Please list any other class, school, or community topics or issues you would like to see addressed during your lessons.
14.
Question - Not Required -
Please provide any additional information that is important for us to know about your class or school, including school closure dates that would impact scheduling.
Spam Control Text:
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