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:

*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:
 : 
Estimated Length of Program:*
Please select all features you wish to include in your 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?*

*Please note: For small groups, the Wildlife In Need Center currently has facilities for on-site education.

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 donations 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 our website to apply.

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