Request Gardening Kits for Your Students

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

What is your name? *

Describe your role in helping care & teach out-of-school students right now? Are you a teacher, parent stepping into fill a void from classroom closures, etc? *

Describe where and how you are taking care of students at-home at this moment? *

How do you plan on using Back to the Roots organic gardening kits with your students? *

Are there any kits that you are particularly interested in using with your students? If so, why? *

How many out-of-school students are you helping care for right now? *

What age are the kids you are taking care of right now?

<5 years old

5-10 years old

11-15

16-18 years old

Have you or any of your students ever been on the free/reduced lunch program at school? (Optional)

Yes

Not sure

Other:

Clear selection

What is your address for your daycare or at-home learning environment? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Back to the Roots.

Does this form look suspicious? Report

Forms