Learn from Harlem Grown!

Learn from Harlem Grown!

This survey will take approximately 5 minutes to complete. Please fill out the form below to tell us how you'd like to learn from Harlem Grown, and a team member will reach out within the next week.
Organization Information
Organization Full Name:*
Please include the official name and spell out any acronyms.
Organization Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Organization Type:*

Charter SchoolCollege/UniversityCorporationDay Care CenterDepartment/Committee/Social ClubIndependent SchoolNonprofitNYCHA or Affordable HousingPublic SchoolTitle I Public SchoolOther
Other Organization Type:*
Form Submitter Information

Please enter your contact information here.
Your Name*

First NameLast Name
Your Job Title*
Email*
example@example.com
Phone*
Please enter a valid phone number.
How did you hear about us?*

EmailFlierInstagramFacebookHarlem Grown WebsiteGooglePrevious PartnershipWord of MouthNews ArticleOther
Partnership Information
What type of partnership are you interested in?*

Mobile Teaching KitchenFarm ToursProfessional DevelopmentService-LearningEducation Session
Please provide details for your proposed partnership here:*
Would we be working with adults, children, or both on this partnership?*

AdultsChildrenBoth
Please give us the age-range of children we would be working with.*

0-PreKK-23-5Middle SchoolHigh School
Approximately how many participants should we expect? (max 30 per visit)*
Preferred time of day for tour?*

MorningAfternoon
Please choose 3 preferred dates. If you are requesting multiple days/a series of opportunities, please note that in the proposed partnership details above.
1st Preferred Date:*

MonthDayYear
Date
2nd Preferred Date:*

MonthDayYear
Date
3rd Preferred Date:*

MonthDayYear
Date
Today Date (for autoname)

MonthDayYear
Date
Service Request Name (form calculation)
Record Type
Should be Empty:

Learn from Harlem Grown!

Organization Information

Form Submitter Information

Partnership Information