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Educators Beyond Kansas
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"We Grow Corn" Books
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NCS Elementary Request

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Company

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Name*

First Last

School Email*

Personal Email*

In case you move schools.

School Phone Number

Cell Phone

Only for delivery purposes.

School*

Grade Level and/or Subject You Teach

Mailing Address*

Where would you like your supplies shipped.

Street Address (Please provide USPS Mailing Address) City State ZIP Code

The mailing address you provided is a*

Home Address

School Address

Materials You are Requesting*

1st Grade Kit

2nd Grade Kit

3rd Grade Kit

4th Grade Kit

5th Grade Kit

1st Grade Kit: Is this a refill or new request?*

First request (I have not requested this kit before)

Refill request (I have received this kit before and just need consumables)

Number of students participating in the 1st Grade Kit*

2nd Grade Kit: Is this a refill or new request?*

First request (I have not requested this kit before)

Refill request (I have received this kit before and just need consumables)

Number of students participating in the 2nd Grade Kit*

3rd Grade Kit: Is this a refill or new request?*

First request (I have not requested this kit before)

Refill request (I have received this kit before and just need consumables)

Number of students participating in the 3rd Grade Kit*

4th Grade Kit: Is this a refill or new request?*

First request (I have not requested this kit before)

Refill request (I have received this kit before and just need consumables)

Number of students participating in the 4th Grade Kit*

Are you requesting kits for multiple teachers?*

Yes

Please provide the name, email and number of students for each teacher receiving a kit.*

How did you learn about this resource offering?*

If you used a National Corn STEM lesson before, farmers want to know what your students learned from the lessons. Can you name at least two things your students learned about corn and/or the ag industry as a result of using a National Corn STEM resource.*

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