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Please tell us a little about yourself and how we can serve you.
(* = required data)
First Name:*
Last Name:*
Email Address:*
Position:
School or District:
School Location:
Urban
Suburban
Rural
Mailing Address:
City:
State:
ZIP:
Daytime Phone:
Ext:
I would like to be on your email list for updates and information, specifically:
(we encourage you to choose 'general information' plus any other category that is appropriate)
General Infomation
Elementary School
Middle and Junior High School
High School
School District level
Principals
Social Workers / Guidance Counselors
Superintendents
Directors of Curriculum/Instruction
I would like to receive a Living Consciously kit by mail.
Please contact me to discuss Living Consciously.
Does your school/district currently offer character education?
Yes
No
If so, what program(s) do you use?
How long has this been in place?
(# of Years)
Is character education optional or mandatory?
Mandatory
Optional
For what grades?
In what format?
Is in-depth statistical tracking available with this program(s)?
Yes
No
If not, what methods are used to prove the effectiveness of the program?
Please give us any other information you would like us to have which will enable us to assist you more effectively:
