Host Business Designers 4 GoodEmpower middle schoolers with skills in entrepreneurship, emotional intelligence, social responsibility and leadership! "*" indicates required fields Leader InfoFirst Name* Last Name* Mobile Phone*(###) ###-####Email* Leader Shirt Size (please note that they run small)* Adult S Adult M Adult L Adult XL Adult XXL I have a green Inside Out Club shirt. Leader Type* Parent/community member with a child in the school Parent/community member without a child in the school Teacher School staff member Other Do you have a co-leader Yes No Leader 2 InfoFirst Name* Last Name* Mobile Phone*(###) ###-####Email* Leader 2 Shirt Size (please note that they run small)* Adult S Adult M Adult L Adult XL Adult XXL I have a green Inside Out Club shirt. Leader 2 Type* Parent/community member with a child in the school Parent/community member without a child in the school Teacher School staff member Other School DetailsType of School*Please Select...PublicPrivateSchool District* 89 202 203 204 Private Other School Name* Session DetailsMax Number of Kids in Inside Out Club BD4G Workshop* Up to 16 kids - new leader Up to 20 kids - experienced leader/educator Days of the Week* Monday Tuesday Wednesday Thursday Friday Start Time*Typically, Inside Out Club BD4G Workshop meets immediately following the end of school for 1.5 hours. If school ends at 2:50 pm please allow the 10 minute buffer and mark time as 2:50 pm to 4:30 pm. Hours : Minutes AM PM AM/PM Schedule (Type our date schedule of dates and include a make-up date (indicate with *) to be used if needed - 13 meeting times total)*i.e. 11/1, 11/3, 11/8 .... *12/15 - for all meetings Room Location*Where the BD4G meetings be held Additional room for presentation day*Name of room for practice while presentations are happening the the meeting room SnacksAll snacks should be approved by the school and be individually wrapped (pretzels or pirate booty) and allergy friendly School/location will provide nut free snacks for students that need one Inside Out Club needs to please provide snacks for students that need one Does the location require a room use form?* Yes No Unsure Who will complete the form?* School will complete the room use form Inside Out Club needs to complete the room use form Does the location require any other forms, etc.? Who will print the flyers to distribute to students at the school?* School, PTA/SFCP, etc. will be able to print the flyers Inside Out Club to print the flyers School will send it out electronically (no paper flyers needed) How many flyers do you need Inside Out Club to print? (# of flyers or TBD)* Leader Training (will also include supply pick-up): Winter - TBD None of these work Does the leader have access to both a laptop and projector for the workshop meetings?* Yes No Leader StipendPlease indicate your choice below. Just by leading you are supporting our mission and we are so grateful! If you'd like to do more, we greatly appreciate it. Stipend Choices* Mail a check for the $596 stipend Mail a check for $350 (donate $246 to support the All in Fund) Donate my stipend to Inside Out Club (where needed most) My school is covering my stipend We are co-leading: contact us to discuss stipend sharing options Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Δ
