Panasonic Sign Up Form

Teacher Name*

First Last

School Name (Please list your full school name)*

Address (Please consider using your home address if you will be teaching virtually as a welcome box will be mailed to you)*

Street Address City State / Province / Region ZIP / Postal Code

Is the address above your:*

Home
School

Mobile Number*

Teacher Email Address*

How many total students do you anticipate in total participating in the project?*

Would you like a hard copy of the student workbooks or prefer to use the editable PDF version?

(If you choose hard copies, we have a limit of 150 workbooks per teacher but if you need more, we ask you to contact us at: Kim@fill.foundation or (718) 483-4262 and options will be discussed.

Grade Level*

Please indicate the subject areas you teach.*

Last Day of School*

Principal Name*

First Last

Principal Email Address*

School District*

How did you hear about our program? Please mention any applicable organizations and associations.*

Do you participate in other eco-projects with your students?*

Yes
No

Please indicate what type of project(s).*

Are the projects done during school or after school?*

During
After

Please let us know how you plan to use the program with your students and any additional comments we may share with Panasonic.*

Will you be submitting your Eco Diary entries digitally or do you prefer to send them in the mail?*

Please note: if you choose to send entries digitally an Eco Diary template and link to upload them will be shared with you over the next few weeks. If you prefer to have hard copy Eco Diaries; we will mail them in your Welcome Kit.

Registration Form