School Services Intake Form
Thank you for your interest in SEEDS! Please submit this form to schedule a meeting with a staff member to collaboratively create a program that meets your needs.
* Required
Email address
*
Your email
School/Organization Name
*
Your answer
Contact Name
*
Your answer
Contact Phone Number
*
Your answer
Contact Email
*
Your answer
Best time to reach you
*
9AM - 1PM PST
1PM - 5PM PST
Monday
Tuesdays
Wednesdays
Thursdays
Fridays
9AM - 1PM PST
1PM - 5PM PST
Monday
Tuesdays
Wednesdays
Thursdays
Fridays
Number of students served by school/organization
*
Your answer
Grade levels served by school/organization
Your answer
Percentage of school on free/reduced lunch
Your answer
Number of staff members at school/organization
Your answer
Why are you reaching out? What issues are you hoping to address?
*
Your answer
Please describe the adult/student and adult/adult relationships at your school/organization
Your answer
How did you hear about SEEDS?
Your answer
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