Start-Up Form

EYPC Start-Up Form
Are you ready to start making a difference in your community? Fill out this start-up form and we will be in contact with you about the next steps!
Implementation Site (e.g.,Local School, Community Office)
Project Coordinator
Fill in information for the project coordinator below.
Project Faciltator
Fill in information for the project facilitator below, if Project Coordinator and Facilitator will be different.
Let us know what date you attended a Facilitator Training.
Program Information
Fill our the below information about your potential EYPC program
Government (e.g., County Board, City Council, Township Board, Village Board, School District Board, Park Board)
(e.g., weekly, bi-weekly, monthly)