CLIF Coins 4 Change Interest Form
Thank you for your interest in our Coins 4 Change Form. Please fill out the below form, and a CLIF representative will respond to your inquiry within 48 hours.
Email address *
Faculty/Staff Name *
Your answer
Date *
MM
/
DD
/
YYYY
School Name *
Your answer
School Address *
Your answer
Grade(s) Taught *
Required
Faculty/Staff Email Address *
Your answer
Phone Number
Your answer
Approximate # of Students Participating *
Your answer
Team Name (ex. Ms. Smith's Shinning Stars) *
Your answer
Will you need a traffic safety kit for your classroom? *
I would like to share this program with other educators (include their emails below):
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