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Program Inquiry
Interest form for potential program sites
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* Indicates required question
Email
*
Your email
YES! Add me to the RuckusRoots mailing list for updates on events and more!
Yes, I'd like to join the Ruckus!
Clear selection
Name (first, last):
*
Your answer
Site Name:
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Your answer
What's your current role in this organization?
*
Your answer
Type of Organization:
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Charter School
LAUSD public school
Community Organization (recreation center/nonprofit):
Other:
Where is your site located?
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Your answer
How many students would you like to participate?
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Your answer
What is the age range of your students?
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Your answer
When are you interested in hosting a RuckusRoots program?
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Your answer
Do you currently have art/and or environmental programming on site?
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Yes
No
If "yes" please tell us a bit more:
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Your answer
Finally, tell us why you're interested in bringing RuckusRoots to your location:
*
Your answer
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