Project EEASY registration form

In order to confirm your Free program you must complete all information below with-in 2 weeks of receiving this form. Registration is a 2 step process:

Fill out the EEASY registration form.
Pick a date and time for your program. (we will confirm exact time in the follow up email)

You will need to repeat this process for each grade level. If you have any questions please contact Cindy Davidson 954-649-7717.

Name of school:

School address:

School phone #:

Lead teacher first name:

Lead teacher last name:

Lead teacher email:

Lead teacher phone #:

Is your school a Title 1 school?

Yes

Does your school primarily cater to underserved students?

Yes

School demographic data is collected to fulfill grant requirements.

Total % should = 100.

School Demographics- % Black students.

School Demographics- % Hispanic students

School Demographics- % Asian students

School Demographics- % Mixed-race students

School Demographics- % White (non-Hispanic) students

Do you have a food forest or garden on your campus?

Yes

No, but we would be interested in one.

Select the appropriate grade level, YEA can accommodate up to 5 rotations of one grade level program per day. Program content is adapted for each grade level.

What grade level will attend this program?

Estimated average class size?

Program class size should ranges between 20-30 students per 1-hour program.

How many classes will be particpating?

Will we have access to a TV or projector with USB ports?

Yes

Please advise if there are any necessary considerations for individuals who may require extra support or accommodations due to physical, mental or development challenges. Please enter N/A if you do not have any.

Pease advise our team where to park on your campus. Please consider our early arrival and your parent drop off line procedures and traffic load.

Your YEA instructor will arrive on campus 1 hour prior to program start time for set-up. Please have someone on campus to direct them to the proper room.

Campus contact:

Campus contact cell #:

Please let us know if you have any questions.

Once this form is submitted, you will be prompted to schedule the date for your program. You must BOOK your program during this session or you will need to complete the above form again.

YOUTH ENVIRONMENTAL ALLIANCE

Project EEASY registration form