Mighty Milers Preliminary Application
Please fill out a separate preliminary application for each school/community center applying.
* = Required fields
Your Contact
Position/Title *
Prefix *
   First Name *
 Last Name *
  
Address 1
Address 2
City
 State
 Zip
  
Email *
Please Confirm Email *
Phone * Work Phone
 Cell Phone
 Home Phone
  
School/Community Center Contact
School/Community Center Name *
Principal/Director *
Prefix * Name * (First and Last)
Address 1 *
Address 2
City *
 State *
 Zip *
  
Phone *
 Fax
 
Questions
1. Have you applied for the Mighty Milers  program before? *

1.1  If yes, for which school/community center?
2. How many kids will participate in the program? *
3. What is the anticipated grade range for participants? * (Mighty Milers is available for Pre-K through 8th grade.)
From :
To :
4. How many days per week will each student participate? *
5. What percentage of students at your school are eligible for free or reduced price lunch? *
(Community centers and other organizations can use the statistic for the local school.)
6. How did you hear about Mighty Milers? *







6.1 If Referred, who referred you?
6.2 If other, please state.