School Programs Interest Form 2021-2022
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First Name *
Last Name *
School *
School District (if applicable)
Grade(s) that you teach *
Which program(s) are you interested in? *
How many students will be participating? (If multiple classes, list the number of students in each class.) *
Do you have a preference as to what month you would like to have your students participate in a Challenger Learning Center program? *
For the month(s) chosen, list date preferences below (if any):
What days and times does your class meet? (If multiple classes/grades, list days/times for each class/grade.) *
Have you previously participated in a Challenger Learning Center program? *
How did you hear about us? *
Your email address *
Your phone number *
Anything else we should know to help with scheduling?
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