Name of Organization:
Address:
Site Address (if applicable):
City:
State:
Zip:
Contact Name:
Title:
Phone:
Fax:
E-Mail:
Website:
Mission Statement:
Please describe your organization's specific
Please describe your staff. Number of professional staff:
Number of volunteer staff:
Are you in need of adult volunteers?
Yes
No
Are you in need of youth volunteers?
Yes
No
Programs currently offered:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Materials currently offered:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Title:
Grade Level:
Cost:
Describe:
Please describe any connections you can between your program/material offerings and current New York State Standards:
Other educational opportunities your organization offers (i.e. volunteer programs, seminars):
Summary of Offerings (please check all that apply):
School Groups:
Teachers:
Youth:
Please grant or deny here permission to include the information provided above on our web site: May we include the information provided above on our web site?
Yes
No
Please grant or deny here permission to include a web link to your organization on our web site: May we include a web link to your organization on our web site?
Yes
No
Please provide us with names and contact information of teachers in Suffolk County middle or high schools you consider to be environmental education leaders (to be published only with contacts' permission):
1.
2.
3.