Core Elements Higher Education Resource Center: Onsite/Virtual Facilitation Request Form
Thank you for your interest in onsite facilitation of the Core College & Career Readiness Program. Please complete and submit the form below.
Name:
*
First Name
Last Name
Email:
*
example@example.com
Phone Number:
*
-
Area Code
Phone Number
High School/Organization Affiliation:
*
Role:
*
Teacher
Counselor
Principal
Assistant Principal
Administrator
Director
Other
What type of service(s) are you interested in:
*
Year Round Core College & Career Readiness Program
Workshops/Webinars for Students
Workshops/Webinars for Parents/Gaurdians
Other
Who is the audience for this request:
*
9th Grade
10th Grade
11th Grade
12th Grade
All Grades
Parents/Guardians
Please select tentative day(s) the program will be offered:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please select tentative starting time(s) the program/workshop will be offered. Core Elements Higher Education Resource Center is in EST:
*
Mornings (Between 8am and 11am)
Afternoons (Between 12PM - 3PM
Late Evenings (Between 3PM - 6PM)
Night (Between 6PM - 8PM)
How did you hear about us?
*
Additional Comments:
Submit
Should be Empty: