Homework Zone Program Pack Use That Book! Webinar

First name: *

Last name: *

Title: *

Company: *

Email: *

Address: *

Address 2:

City: *

State: *

Zip: *

Phone: *

Your primary role in afterschool programs?: *

How long have you been in the afterschool field (years/months)?: *

How many students attend your program each day?: *

How many paid staff work in your afterschool program?: *

What grades does your program serve? [Check all that apply]: *

Pre-K

Elementary

Middle School

High School

Program Setting(s)? [Check all that apply]: *

rural

small town

suburban

urban

Why did you choose to attend this session today?:

Do you own or have access to Homework Zone Program Pack?: *