"Screen Smart Sam" Free Books for Parent Engagement Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in receiving free copies of the children's book "Screen Smart Sam" to distribute/gift to parents to assist in supporting digital citizenship education efforts your community! A big thank you to www.OurPact.org and Honda of SoCal for their support in making this possible!

Please complete the following form so we may consider your application. We will be matching requests with local or national sponsors. Currently we are prioritizing requests for teacher applicants in Southern California and the USA, as well as Instagram giveaway winners-- maximum of one class set per school year per teacher to send home as a gift to parents so it may be read multiple times at home (ideally with an activity or guidance from teacher about how to best utilize the tips in the book). We can assist in helping teachers craft an outreach letter or activities with screen guidance to maximize the benefits about learning healthy screen routines!

First Name

Last Name *

Instagram Name if applied via contest

School or Organization *

Grade *

School District *

Street Address of Your School *

City

State

ZipCode

Email address *

Do you need a preview PDF copy of the book? *

Yes please email it to me

Nope, already have a copy or have seen the preview

How many copies would you need to send one home to every family in your classroom? *

WHAT DATE WILL YOU GIVE THE BOOKS TO FAMILIES? (this school year, next...approximate is fine if in the future)

YYYY

Would you be willing to take some photos of the donation to share with sponsors and social media? Either picture with you with the books, books in your classroom, back view of children receiving the book, or consenting parent & child receiving the book? Priority will be given to teachers/schools who can help spread the word about this great resource. *

sure!

Required

Are you interested in any of the following (check all that apply) *

creating my own digital wellness worksheet to use with the book lessons (or already have)

Screen Smart Sam coloring pages

Workshop for parents in person or online hosted by a Screen Time Clinic educator

Virtual book reading w/Q&A (if you are teaching online)

Screen Time Clinic created worksheets for students

Posting on your own social media about Screen Smart Sam and importance of digital citizenship

Required

Does your school have a PTA or PTO group? If so what is the email for the contact person for the organization? Many schools do not have parent fundraising organization. We would like to give your school's PTO the opportunity to sponsor the books so more may be donated to schools without supplemental funding available. *

Anything else we should know about you, your class or students?! Thank you for your interest in receiving and distributing this great resource to help kids and families create healthy technology habits! *

How did you hear about this donation opportunity?

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

Forms