I am the *

First Name *

Last Name *

Phone *

Email *

In what location will PEP take place ? *

Any Alternative Space? *

Type of Enrichment Program Interested In *

Enrichment Program Interested In *

Does your school or organization follow the DOE Holiday Schedule ? *

School Type *

Input All Grade Levels To Service *

Any IEP participants? *

School *

Address *

City *

State/Province *

Zip/Postal Code *

3 weeks are required prior to start date of proposal agreement *

Overall Anticipated Number of Participants to be Serviced per Hour? *

Overall number of participants to be serviced in the program? *

Anticipated Start Date (Minimum Engagement 2+ Months) *

Anticipated End Date (Minimum Engagement 2+ Months) *

Anticipated Start Time *

Anticipated End Time *

Anticipated Hours Per Day *

Estimate Budget Required for Implementation of PEP School Hours? (2+ Months) *

Estimate Budget Required for Implementation of PEP Holiday or Summer Camp Hours? *

Do you have the allocated estimate budget to implement the program chosen above? *

Choose PEP Payment Option *

Choose PEP Payment Option-Camps *

PEP Additional Comments *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply.