Jump Start Program Application
Application deadline is January 31, 2017. For more info about the Jump Start fleet, please visit thestreettrust.org/jumpstart

For information about the The Street Trust's October and May Walk+Roll events, please visit the walknbike.org or thestreettrust.org/walkroll.

Your name *
Your answer
Your email address *
Your answer
Your phone number *
Your answer
Name of School/District/Organization *
Your answer
City *
Your answer
Have you spoken to your school district about the Jump Start Program? *
The schools are integral to having a successful program.
Required
If yes, are they willing to be an active partner of the Jump Start Program? *
Without the school district on board, running an in-school program that reaches the most students with the least amount of resources is very difficult.
Required
School District partner: Name *
We would like to contact your partner at the school district to confirm support!
Your answer
School District partner: phone number and email *
Your answer
How many students do you expect to reach with the Jump Start Program materials? *
Your answer
How many staff members/community members do you anticipate to attend the curriculum training? More attendees is better! *
Your answer
Does your school/district/organization currently provide any walking or biking education or encouragement?
If you checked anything other than none above, describe your Pedestrian/Bicycle Safety education programs currently:
Your answer
What are the goals of your school/district/organization for the next 12 months regarding walking and biking? *
Your answer
Additional district contact names, email addresses and phone numbers (more contacts will strengthen your application):
Your answer
Please explain what makes you feel this program will be a success in your district? *
Your answer
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