Request a Program

Education Program Request Form


Group Name:*
Type of Organization:*
Primary Contact Name:*
Contact Address:
Phone Number:*
-
E-mail:*
Preferred Contact Method:*
Location for Presentation:*
Presentation Address:

*Please note: For small groups, the Wildlife In Need Center currently has facilities for on-site education. If you wish to hold the program at WINC, please leave the Location Address blank.

Estimated Attendance:
Preferred Date:*
Preferred Time:*
 : 
Age/s of Group:
Alternate Date:
Alternate Time:
 : 
Number of Programs*
Please Choose the Type of Program:*
Estimated Length of Program:*

If you have selected a program with our educational ambassadors and/or a PowerPoint presentation, please select the program option(s) you would like.

Please follow this link to our Program Options to find more details about what each option entails.

Program Options:*
If the program is at your location, which of the following items are you able to provide?*
Girl Scouts - please list the pedal/badge your troop is working towards below:
WINC Program History:

The Wildlife In Need Center's education program fees are listed on the Wildlife Education page on our website.  The fees can be met monetarily, through in-kind collection of items from our wish list, or a combination of both. 

We also have an opportunity for groups to have the program fee to be covered partially or in full by means of a grant/scholarship that we offer through our center. The grant is called the Leslie Kiehl Education Program Fund. Please visit this page on our website for more information or to apply.

Fee Agreement*
Comments:
Group Name:(1)*