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) *
Title/Affiliation *
E-mail *
Phone *
How did you hear about 4 What's Next? *
Which option best describes your intended use of the program? *
You can select more than one option
Required
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.)
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.
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
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