WildCare - Survey - DateRequest_WildlifeAmbassadorProgram

Please enter the following contact information:

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Name:

First Required	Last Required

*

Email: Required

Phone Number:

Yes, I would like to receive e-mail from WildCare

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Question - Not Required - Please enter the preferred date for your Wildlife Ambassador Program (Tuesday through Friday):

Question - Not Required - Please enter an alternative date:

Question - Not Required - Please enter a third alternative date:

Question - Not Required - How many presentations would you like at your school in this visit?

Question - Not Required - What time would you like the first presentation to start? (Please allow no more than 20 minutes between presentations)

Question - Not Required - Name of school:

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Question - Required - School telephone number and extension:

Question - Not Required - What is the school's address?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Teacher's cell phone number:

Question - Not Required - Please tell us what grade level:

Question - Not Required - How many classes are interested in participating in this Wildlife Ambassador Program?

Question - Not Required - Approximately how many students (total) will participate in this Wildlife Ambassador Program?

Our Wildlife Ambassador presentations include a short PowerPoint presentation about WildCare and an introduction to three of our non-releasable, educational wild animals.

We can tailor the theme of the presentation to your class/group’s needs, however, we are unable to guarantee particular animals (though you can make a request).

Our current themes are "Feathers, Fur, and Scales" and "Animal Adaptations." Both of these programs are appropriate for all ages.

Question - Not Required - Requested theme of presentation (see information above):

Do you need to apply for a scholarship for your Wildlife Ambassador Program?

Question - Not Required - Yes/No

If yes, please complete the questions below:

Question - Not Required - What percentage of students at your school is eligible for the Free or Reduced Price Meal (FRPM) program (see link below to determine percentage):

(Click here for the link to the current year Free or Reduced Price Meal (FRPM) information on WildCare's Scholarship Information page.)

If you are able to accept a smaller scholarship it would be greatly appreciated, as this will enable us to reach even more students in the Bay Area.

Question - Not Required - What amount can you afford to contribute?

Question - Not Required - Please share how receiving this scholarship would benefit your students' educational experience?