EmailMe Form - Shelf Life Application

Workshop or Organization Name *

Location (City, State) *

Workshop Main Contact Name *

Contact Email *

Contact Phone

### - ### - ####

Who runs this program?

Program Description *

Please provide a brief overview of your program's goals, setup, and history.

Demographic Description (Example: Prison programs, after-school initiatives, etc) *

Please be as specific as possible, including any names of affiliated organizations and the program location(s).

Is your program open to the public?

Yes

No

Other:

Is your organization a non-profit?

Yes

No

If yes to the above, what is your tax ID number?

Does you wish to apply for the Shelf Life Library Pack?

Yes

No

Do you have the resources to pay for the kits? ($100 for 50 books)

Yes

No

If no, would you like your program to be placed on the wait list for a free set? Programs will be accommodated on a first come, first serve basis.

Yes

No

By clicking the box below, you agree to our terms of service. *

I agree.

No, thanks.