Recording Program Quote

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You're one step closer to changing lives!

Congratulations! Together we are going to change the lives of your students. In just 5 short minutes you can give us all of the information that we need to prepare your detailed quote. It will be sent to you via email within 48 business hours of submitting the form below.

We look forward to partnering with you this school year!

Name *

First

Last

Position Title *

Phone *

Email *

Do you need a quote for multiple locations? *

Yes
No

Number of Locations *

We'll get specific information for each location later in the on-boarding process

Location Names & Population

Leave blank if you don't know the schools yet

Individual School Demographic

Leave Blank if you're not sure

School Name *

First Time Participant *

Yes
No
I'm Not Sure

Will this be your school's first time on our program?

School Address *

Address Line 1

Address Line 2

City

State

Zip Code

Grade Level *

K8
High School
Mixed

Explain Mixed

Estimated Student Population *

Important to determining program viability.

Student Demographic *

This information is required to helps us understand the possible needs of your students

Fiscal Agent *

What agency will be responsible for payment of services and binding of service contract?

Explanation of Other *

Who will be responsible for managing iSupplier PO? *

Myself
Other Resource Coordinator
Other Business/Account Manager

Responsible Agent Name *

First

Last

Email *

Service Agreement Signatory *

Yes
No

Will this contact also be responsible for signing any written agreements?

Program Goals

Please let us know if you have any specific goals for the program.

Program Details

How many days per week do you desire *

1
2

Selecting "Either 1 or 2" will let us know to send you a proposal for both options

Week day preference *

Monday
Tuesday
Wednesday
Thursday
Friday
No preference

Which day of the week do you prefer to hold programming? SUBJECT TO AVAILABILITY

Program Terms *

Spring 2020
Summer 2020

A full year discount is applied when you lock in programming for both semesters

Desired Program Duration *

8 Weeks
10 Weeks
15 Weeks

How many weeks per semester is ideal for your location. Most of our programs run for 10 weeks. MAX OF 10 WEEKS FOR FALL 2019

Desired Start Date *

How soon do you desire to begin programming? This is not set in stone but will serve as a target bench mark.

School Bell Schedule

Please provide your school's bell schedule here. School Start and end times, special early dismissal days, etc.

Number of lunch periods *

How many lunch periods are in your school day? This is important for scheduling your onsite promo day.

Time of Lunch

What time are your school's lunch periods

Multiple Lunch Rooms *

Yes
No

Does your school use multiple lunch rooms simultaneously?

Handicap Access *

Yes
No

Is the school handicap accessible?

Are all locations handicap accessible? *

Yes
No

Which locations ARE NOT *

Special Notes

Type any special notes that we may need to know here. Special accommodations, etc.

Program Budget per Semester *

$4k-6K
$6k-10K
$8k-15K

This is your program budget for each semester.

Phone

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Beyond Limits Media Group LLC
Chicago, IL 60617
(773) 948-9296
[email protected]

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