Education Request-Lowcountry

Please complete the survey and allow 2 weeks from submitting it for a response. Questions about your request may be directed to sandi@komensc.org. If you need materials for more than 100 people, please download them from our website.

1. Please provide your contact information.

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Name:

 

 

   

*

 

 

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City/State/ZIP:

 

    

 

 

 


*2.
Question - Required - By what date do you need your materials?




*3.


4.
Question - Not Required - What is the date of your event?




5.  


*6.

*7.
Question - Required - Is the requesting organization one of the following (select all that apply)
Please make between 1 and 6 selections from the choices below.

*8. What type of event are the materials being used for?
(Select one of the available choices or enter a different value.)



*9.
Question - Required - Select up to three topics of interest.
Please make between 1 and 3 selections from the choices below.

*10.
Question - Required - Who is the primary audience (select all that apply)
Please make between 1 and 3 selections from the choices below.

*11.  


*12.  


*13.
Question - Required - Is this request to reach any of the following special populations? If yes, select up to 3.
Please make between 1 and 3 selections from the choices below.

*14.
Question - Required - What counties will be served by your event?
Please make between 1 and 3 selections from the choices below.

*15.

   Please leave this field empty