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2. 1st and 2nd Grade 9-1-1 Education Presentation Request Form

4. Presentations are available to 1st-grade students who attend school within El Paso and Teller County, Colorado. Presentations are interactive and include materials for participation. Each presentation runs approximately 45 minutes.  Please schedule one class per presentation. 

   
   

6. First Name*
7. Last Name*
9. Email Address*
10. School Name*
12. School Address*
14. City*
15. State*
16. Zip Code*
18. School Phone Number*
19. Best Phone Number to Reach You*

21. Please schedule one presentation per class. Each presentation is 45 minutes. If scheduling multiple classes, please allow time for the instructor to move between classrooms and set up equipment. (5 minutes)

23. Presentation 1: Date*
    Presentation 1: Date
24. Time:
    Time: Start Time

    —

    Time: End Time
25. Total Students
27. Presentation 2: Date
    Presentation 2: Date
28. Time:
    Time: Start Time

    —

    Time: End Time
29. Total Students
31. Presentation 3: Date
    Presentation 3: Date
32. Time:
    Time: Start Time

    —

    Time: End Time
33. Total Students
35. Presentation 4: Date
    Presentation 4: Date
36. Time:
    Time: Start Time

    —

    Time: End Time
37. Total Students
39. Additional Requests

    If the date/time you requested is unavailable, let us know what alternate dates/times work in your schedule. If you have questions or special requests, you can enter that information here as well. 

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

* indicates a required field