Community Outreach Request Form
Email address
Your Organization
Ex: Board Games Club, ABC Middle School, XYZ Library, Math 2 Class
Your answer
Address
Your answer
Contact Name
Your answer
Contact Title/Role
Your answer
Request
I am interested in
Required
Preferred Timeline or Deadline
Spring 2017, mid-August, twice a year, or a specific date in mind for this request.
Your answer
My goal with this request is to ...
Build a partnership, reinforce key concepts in my class, introduce students to more careers, help students pursue their current interests, etc.
Your answer
Request Description to be posted on website
If seeking volunteers, please provide a well written description of your request we can post to our website/newsletter.
Your answer
Comments
Anything else you would like us to know?
Your answer
Eligibility
Leaving these answers blank will NOT automatically disqualify your request.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Kansas City Women in Technology. Report Abuse - Terms of Service - Additional Terms