| By filling out and submitting the following information, the Schoolyard Habitats™ Coalition can determine goals and objectives to best assist your schools' environmental projects. Please type or print all information. |
Date _________________
School Name _________________________________________________
School Address_________________________________________________________________________
School Phone Number _____________________________ School Fax Number _____________________
Type of School: ___ Public ___ Private ___ Charter ___ Parochial ___ Home
Does the school have a particular focus? ___________________________________________________
School Principal's Signature _____________________________________ Date ____________________
Project Contact Person ________________________________ Relationship to School ______________
Contact Address _______________________________________________________________________
_____________________________________________________________________________________
Home Phone ______________________________ Work Phone _________________________________
Mobile Phone _____________________________ FAX ________________________________________
Email ___________________________________
When is the best time to contact you? ______________________
Which method of contact do you prefer? ___ Home ___ Work ___ Mobile ___ Fax ___ Email
Are you familiar with the Schoolyard Habitat™ Program? ___ Yes ___ No
If yes, is your goal to become a certified Schoolyard Habitat™? Please explain ___________________
____________________________________________________________________________________
| Thank you for taking the time to complete this interest form. A representative of the Schoolyard Habitats Coalitionwill contact you soon to set up a site assessment. ? |
Please submit completed form to:
NC
Wildlife Federation
2155 McClintock Road, Charlotte, NC 28205
Email: greta@ncwf.org Phone: (704) 332-5696
Fax: (704) 332-2240