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2. Education Presentation Request Form

   Keep Norfolk Beautiful offers four in-person presentation programs for Pre-Kindergarten through 6th grade. Each lesson is designed to help Norfolk students learn more about their impact on the environment and what they can do to help. 

4. Requestor First Name*
5. Requestor Last Name*
7. Requestor Phone Number*
8. Requestor Email*
10. Facility Name*
11. Facility Address (please include zip code)*
13. Presentation Requested*
    -- Select One --Reduce, Reuse, Recycle (Pre-K-1st)Henry the Heron (K-2nd)The Preventable Journey (2nd-1st)Plastics in Our Environment (4th-6th)Other
14. Group Type*
    -- Select One --Norfolk Public SchoolNorfolk Private SchoolHomeschool GroupAfter-School ProgramSummer ProgramClub or Student OrganizationOther
15. Grade Level of Students*
    Please indicate what grade, or grades, will be present for the presentation.
17. Number of Students Per Class (must be less than 15)*

    Please indicate how many students are expected to be at, or participating in, the presentation.

18. Number of Classes*

    Please indicate how many times you would like KNB to give the presentation.

19. How many adults will be present?*

    KNB requires at least one adult to be present throughout each session.

21. 1st Preference*
    1st Preference

    1st Preference
    Please let us know your date and time preference for the presentation. The presenter will be in touch to confirm or offer an alternate date or time if needed.
22. 2nd Preference*
    2nd Preference

    2nd Preference

    Please let us know another date and time preference for the presentation in case your first preference isn't available.

24. How did you hear about Keep Norfolk Beautiful's Education programs?*

    1. Google or other search engine
    2. Family/Friend/Co-worker
    3. Social media
    4. KNB staff
    5. Other
26. If you indicated "Other" for any questions above, please specify.
28. Agreement

    - KNB staff agrees to arrive prior to the scheduled time to allow adequate time for setup before the presentation begins.

    - The requestor will ensure that an educator or assistant will be with each group at all times during the presentation.

    - KNB staff and the requestor agree to communicate any changes or issues regarding the presentation with adequate notice.

30. Additional information, questions, comments or concerns.

    Please let us know any details that might help the presenter prepare for the presentation. Use this space if more than one class is interested in participating. List additional classes, grade level, and number of students. Please indicate if activity will be done in one location or  if the presenter will move to each classroom.

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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field