4 What's Next Registration Application

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To purchase or renew one or more 4 What's Next program licenses, please submit this form and a Jordan Porco Foundation staff member will review your application. If approved, you will receive an invoice in the amount of $500 multiplied by the number of sites you are seeking licenses for. 1 license allows for unlimited use of the 4 What's Next program for at a single implementation site. You and any unique designated site contacts listed will receive invitations via the e-mail addresses provided to access the Facilitators web content at 4whatsnext.org. Access will expire 1 year from the date issued, unless alternate arrangements are made. If you wish to purchase more than 10 licenses at this time and/or would like to bundle and save with JPF's Check In program, please contact Leah Nelson at lnelson@jordanporcofoundation.org.

REGISTRANT INFORMATION

Please include your information below

First Name *

Last Name *

E-mail *

Phone *

Your Organization Name *

Title/Affiliation *

Organization Street Address *

Organization City *

Organization State *

Organization Zip Code *

USAGE

How did you hear about 4 What's Next? *

I have utilized the program before

Conference/presentation

I heard about it from another organization that has utilized the program

Listserv/mailing list

Web search

Someone from the Jordan Porco Foundation reached out to me

Other:

Which option best describes your intended use of the program? *

You can select more than one option

I plan to run the program once with a single group of students

I plan to run the program with multiple groups within the same site/location/program

I plan to open the program up to students outside of my site/location/program

I plan to run the program across multiple sites/locations/programs

I am purchasing the program for another group's use and will not be directly involved with implementation

Other:

Required

How many sites would you like to purchase licenses for? *

This form can collect details for up to 10 sites. If you are purchasing licenses for more than 10 sites, you will be asked to submit additional site details separately.

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This form was created inside of Jordan Porco Foundation.