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Making It Count Programs Sign-Up Form
Sign-Up for Making It Count's Programs

You may sign-up for Our Presentations by completely filling out the information below.

Please note: A minimum participation of 100 students is preferred in order to qualify for a presentation. We will contact you to confirm our ability to deliver the presentation and to finalize your specific date and time. Please check your input for any inaccuracy before clicking the Submit button at the bottom of the page.

Fields denoted by an asterisk (*) are required.

School Contact Information
Contact Name: *
Contact Title:
School Name: *
School Address: *



City: *
State: *
Current Zip Code: *  - 
School Phone Number: * (  )  - 
School Fax Number: (  )  - 
Email Address: *
Total number of students in school: *
Percentage of seniors going on to two or four year colleges/universities: * %
How did you hear about us?:


 
 
Program Scheduling Information

Making High School Count

Making College & Career Count
Please enter your top three choices: (approximately 45 minutes in length)

1) Date/Time:  /  /   
2) Date/Time:  /  /   
3) Date/Time:  /  /   
Number of seniors in current class: