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Special Short-Term Groups Online Request Form
*
Required Field
*
FULL AGENCY / SCHOOL NAME:
*
FULL MAILING ADDRESS:
*
FULL OFFICE ADDRESS (IF DIFFERENT FROM MAILING ADDRESS):
*
PRESIDENT / DIRECTOR NAME:
*
YOUR NAME:
*
TEL:
FAX:
*
EMAIL:
URL / WWW:
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Which program option are you interested in?
(To see program options, click here.)
Option One
Option Two
Option Three
Other (special request
**
)
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If you are making a special request, please stop here and go to the bottom of this form to complete the box designated "for special requests".
*
How many students do you expect to participate in the program? (minimum 10 students)
10 - 20 students
20 - 30 students
30 - 40 students
more than 40 students
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Length of program you are seeking?
2 weeks
3 weeks
4 weeks
more than 4 weeks
*
When would you like your program to begin?
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2005
2006
2007
2008
2009
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FOR SPECIAL REQUESTS:
Please specify the type of program you are interested in. Include number of students and program duration. After reviewing your request, we will contact you regarding your proposal.
We look forward to working with you!
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