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PROGRAMMING ACTIVITY REQUEST

Workforce Partnership Programming Activity Request

Please use this request to schedule a programming activity. 1. Please submit only one activity per request. 2. Please request no more than (2) dates for the activity. 3. Be sure to identify time range(s) for each date; multiples can be listed (separate with a comma). 4. If you have questions, please call our office at 937.498.9900.

"*" indicates required fields

Name*

First Last

Email*

Phone*

School*

Anna

Botkins

Christian Academy

Fairlawn

Ft. Loramie

Houston

Jackson Center

Lehman

Russia

Sidney

Sidney Opportunity School

Grade Level (select all that apply)*

K-2nd

3rd-4th

5th-6th

7th

8th

9th

10th

11th

12th

What activity are you requesting?*

Explanation for "Other Activity"

If classroom speaker is requested, what is your topic request?*

Workforce Partnership & Hometown Opportunity

Manufacturing Company and Careers

Construction & Skilled Trades Company and Careers

Healthcare Company and Careers

Food/Agriculture Company and Careers

Parts Suppliers and Logistic Company and Careers

Other Topic (If Other, explain below)

Explanation for "Other Topic"*

1st Date requested:*

Start & End time(s) requested:*

2nd date requested (if needed):

Start & End time(s) requested for 2nd date:

Special Instructions/Comments:

101 S. Ohio Avenue, Floor 2
Sidney, Ohio 45365

Phone
(937) 498-9900

WHAT’S YOUR E?

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