Students Creating Smiles Interest Form

Contact Information

I am a...*

Name*

First Last

Title

Student's Name

Email*

Mailing Address for any mailed collateral (posters, brochures, etc.)*

Street Address Address Line 2 City State ZIP Code

Name of School*

School Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

County School is Located In

Grade Levels Expected to Participate (Check all that apply)*

Other (grade level):

Club or Organization

Please select a time frame for when your fundraiser might take place.

How many students do you anticipate would be participating in a fundraiser?

What type of fundraiser do you plan on hosting?*

Walk-A-Thon
Coin Collection
Digital Fundraising Campaign
Car Wash or Bake Sale
Jeans or Pajama Day
Pie a Teacher
Carnival or Special Event
I'm not sure yet and would love to brainstorm some ideas with the A Kid Again staff
Other (Specify Below)

Other Fundraiser

Would you be interested in learning more about incorporating A Kid Again educational materials in your fundraising methods?*

Please provide any additional information that might be helpful for A Kid Again to know regarding this fundraiser.