Client Intake Form
Email *
Name *
Phone number *
Company *
Which Girl Code program(s) are you interested in? (Check all that apply)
Expected Number of Participants (Only fill out if inquiring about programming or materials)
Preferred Start Date
MM
/
DD
/
YYYY
Preferred Days of the Week
Preferred Time of the Week
What are your goals and expectations for implementing the Girl Code program in your school/organization?
How do you envision this program benefiting your students/educators? 
Is there anything else you would like us to know or consider about your school/organization's needs?
Do you have a budget allocated for implementing the Girl Code program or services in your school/organization? If yes, please provide an estimated budget range.
*
Yes, I have a budget range of (answer below)
Is there anything else you would like us to know or consider about your school/organization's needs?
Comments
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms