Request edit access
Clean Air School Kit Request Form
Each kit is valued at $250. Currently, we are very low on supplies, but are expecting to receive additional funding end of November or December.

The Clean Air School Kit is made possible through a collaboration of the top orgaizations working on Air Quality Education in Utah including: Breathe Utah, EPA, Utah Clean Cities, Utah Asthma Program, and the EPA.

Utilizing the Clean Air School Kit earns credit toward Utah Green Schools recognition, but applying is not a requirement to receive the items. For information on Utah Green Schools, please visit: http://usee.org/programs/utahgreenschools

First Name
Your answer
Last Name
Your answer
School Name
Your answer
Position
Your answer
Email
Your answer
Phone
Your answer
School Street Address
Your answer
School City
Your answer
School Zip Code
Your answer
District Name/Charter/Private
Your answer
Number of students at your school
Your answer
Number of families at your school
Your answer
Number of staff & faculty at your school
Your answer
Do you already have 2 Utah Clean Cities Idle Free Round signs?
If you already have Idle Free Clings for the 2017-2018 school year, how many do you have or have already handed out? This can help us plan for numbers in the following years.
Your answer
If no, please answer the following:
It is recommended to host a campaign where students hand out the clings and fact cards to parents dropping off/picking up. Or, a cling and fact card can go home with the oldest student of each family. Depending on which situation works best for your school, please answer the following accordingly.
If interested in hosting a campaign, how many cars do you estimate come through at drop off/pick up?
Your answer
Are you able to print your own Idle Free Fact Cards? It is strongly recommended to attach an Idle Free Fact card with each cling that is given out. We can only provide the digital version with 4 per sheet currently.
Does your school already have an EPA Air Quality Flag set?
If no, would you like a flag set to participate in the EPA Air Quality Flag Program for your school?
If yes, how is it being used?
Your answer
Does your school have an electronic newsletter or email listserv through which informational flyers could be sent to parents?
Would you like to receive information on being recognized as a Utah Green School?
Do you agree to share this information with the sponsoring organizations for their records and any possible follow up? (Breathe Utah, EPA, Utah Clean Cities and Utah Asthma Program)
Any comments or questions?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Utah Society for Environmental Education. Report Abuse - Terms of Service - Additional Terms