Challenge Leadership Programs School name______________________________________City________________State_____ School telephone number: ________________________ School fax number: _______________ Name and address of the facility where the Challenge Program is to be held: ____________________________________________________________________________ ____________________________________________________________________________ ________________________________________________ Telephone number: ________________________________ Detailed directions from Indianapolis to program site: (assume we are geographically illiterate) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Approximate travel time from Indianapolis: ____________________________________________ The person greeting the Challenge facilitator will be: ____________________________________ Home telephone number: ______________________________ Number of students attending: _____________________ Grade level of students:____________ Number of staff or parents attending: _______________________________________________ Program starting time: _____________________ Program ending time: ____________________ School contact person: ______________________________ Telephone number: ____________ Approximately how many of these students have attended a Challenge Leadership Program before? _______________________________________________________________ If over-night lodging is necessary please list two hotels near the program site. ____________________________________________Telephone:________________________ ____________________________________________Telephone:________________________ |
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