LITERACY MONTH 2014 PROVIDER survey
RequiredRequired Question(s)
1.
Please enter the information below to receive a FREE children's book for your classroom.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

Please indicate the number of children that participated in the Literacy Month Activity. 

 

50 characters left.
Required 3.

Please choose below the age range of the children that participated. 

Toddler
Preschool
Kindergarten
School age
Required 4.
Please check off the activities that you participated in with your child(ren)- **must have participated in at least 1 to be eligible for the FREE Book:
Have a Wild Rumpus
Make a Wild Thing Mask
Cook up some Wild Things Pancakes
Other  
*** DON'T FORGET.... 
In addition to participating in an activity, you MUST also submit a picture of your children reading or participating in one of the activities from this project by December 12th.  You can submit them to mdavidson@selfhelpinc.org