4 What's Next Registration Application
To purchase one to five 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 a licensing agreement and invoice in the amount of $300 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 one year at a single implementation site. The program is intended for use with small groups not to exceed 30 students. If you wish to purchase more than 5 licenses at this time or have a unique situation that may require or qualify for a custom licensing fee, please contact the Program Manager at lnelson@jordanporcofoundation.org.
Name (First and Last) *
Your answer
Title/Affiliation *
Your answer
E-mail *
Your answer
Phone *
Your answer
How did you hear about 4 What's Next? *
Your answer
Which option best describes your intended use of the program?
You can select more than one option
How many sites would you like to purchase licenses for? *
This form can collect details for up to 5 sites. If you are purchasing licenses for more than 5 sites, you will be asked to submit additional site details separately.
How will the program be embedded into your program/institution? *
(part of class requirement, after school club, peer leadership training, youth group, etc.)
Your answer
How many students do you estimate will participate in the program by the end of the 1 year licensing period? *
Please factor in all participating sites. Remember the suggested group size is 15-30 students.
Your answer
What are the ages of participating students? *
Check all that apply
Required
How many facilitators will be designated to implement the program and access training and implementation materials? *
Please factor in all participating sites
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Jordan Porco Foundation.