Program Request Form - Read with Malcolm
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Email *
School Name: *
School Address (Please include city, state & zip): *
Principal's Name: *
Principal's Phone Number: *
Primary Contact: *
Primary Contact Cell Phone: *
Primary Contact Email Address: *
Number of Students: *
Number of Teachers: *
Grade Levels: *
Number of Books Requested: *
Program Options: *
Required
What overall goal would you like to accomplish by bringing our program to your school? *
Target program date: *
Currently accepting Fall 2024 dates only.
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Book Options (Please select one book to be used with your program): *
Are you interested in applying for a Share the Magic Matching Grant (Must be a Title 1, 90% Free/Reduced Lunch school to receive a Grant) *
Which major airport is closest to your school? (Please provide airport code if possible.)  *
How did you hear about our programs? *
A copy of your responses will be emailed to the address you provided.
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