iPad Evaluation

Your Name*

First NameLast Name

Your Email Address*

example@example.com

Your Phone Number*

Please enter a valid phone number.

What school do you work at?*

Is your school located in the Costa Mesa School District?*

YesNo

What is your position at the school?*

Check all that apply. Which program would you like to request participation in?*

Reward with chicken (Program available to Costa Mesa Teachers)Fundraising with chicken (Program available to Costa Mesa Schools)Something Else

If you are a teacher expressing interest in the Reward with Chick'n program, how many digital offer coupons would you need for your classroom?*

I understand that I will be asked to present my teacher or faculty ID card to verify that I am a current teacher or staff at a school in the Costa Mesa school district as part of this request.*

I understand

Anything else? If you have any initial questions or additional comments you need to let us know for your request, feel free to express them here

Please Read

After pressing submit below, our team will review and process your request and follow up with you via email within 10 business days from time time of your request.

Please double check that the contact information you have provided above is correct before submitting your request.

At this time, we will not be taking requests in store or over the phone. Our team will be happy to answer any and all questions you have when they follow up with your request.

As a reminder, requesting participation in any of our School Programs is not a gaurantee that participation will be accepted. Our desire is to support as many teachers and schools as possible within the Costa Mesa school district, while supplies last.

I have read and understood the above statement*

I understand and agree