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EDUCATOR INTEREST FORM

Please fill out form completely to receive information about our nonprofit organization, our classroom lessons, educator training workshops and other programming.

Email*

First name*

Last name*

Name of School*

Type of School*

Pre-K to Kindergarten

Elementary School

Middle School

K-8 School

High School

Alternative School

Other

Subject(s) Taught*

Science

Math

Reading/English

Music, Drama, Art, and/or Dance

PE/Health

All subjects

Work Phone*

Cell Phone

Interested in Free Programs about NIHL and Its Prevention? (check all that apply) *

Hearo Saves the Day! (Book-based educational materials for Pre-K to 3rd Grade)

Classroom Program for Elementary Students(4th and 5th graders)

Classroom Program for Middle School, High School, and Older Learners

Program for Educators (professional development module)

Protect-A-Band Program (for Band Directors and their student musicians)

Other

Where did you hear about us?

Please provide any other information you would like us to know.

a 501 (c)(3) tax-exempt foundation

HEAR WHAT’S NEW!

To stay up-to-date on hearing health information, fill out the form on the next page to receive updates.

Take Me to the Form

info@earpeacefoundation.org

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