Salutation

Mr. Mrs. Miss Ms.

Please select salutation from above

First Name

Last Name

Email Address

Which best describes you? Select… Character Building Educator Social Studies Teacher School/Guidance Counselor Alternative/At Risk Teacher At Risk Director/Coordinator Dropout Prevention Coordinator Life/Personal Skills Teacher School Principal Other School Administrator (Specify) Curriculum/Program Director Public Education Administrator Professor (College/University) Assitant Professor (College/University) Other College/University (Specify) Community Educator Continuing Education Instructor Parent-Teacher Association School Librarian Other Teacher/Educator (Specify) Youth Organization (Specify) At-Risk Youth Services (Specify) Social Worker/Counselor Athlete/Athletic Trainer Ministry/Clergy Other Youth Work (Specify) Human Resources Manager Business Ethics Officer Business Training Facilitator Employee Assistance Corporate Executive/Administrator Healthcare Professional Law Professional Employee Media Other Professional/Business (Specify) Correctional Educator (Specify) Juvenile Corrections (Specify) Transition/Re-entry (Specify) Probation Officer/Official Parole Officer/Official Prison Warden Jail Staff/Official (Specify) Other Corrections Officer/Official (Specify) Police Chief/Officer Sheriff/Deputy School Resource Officer Community Resource Officer Law Enforcement Youth Program Other Law Enforcement (Specify) Legislator Judiciary (Specify) Military Other Government (Specify) Parent Student Artist Volunteer (Specify) Other (Specify)

How did you find out about us? Select… Booklet/Handout Class/Teacher Colleague Event/Presentation Family Member Friend Information Kit Internet Ad Other Internet (Specify) Magazine Ad Media Report Postcard Seminar TV Ad Other (Specify)