COLORADO CLASSROOM

Request K-3 Educational Materials to be mailed to your home.

Your privacy is critically important to us at Rocky Mountain Public Media. The personal information we ask you to provide on this form will only be used for the purposes of this mailing, and we will only store your information as long as we have reason to keep it. If you have any concerns about the information we request here and would prefer to contact us directly, please call our toll free number: 800-274-6666

Are you submitting on behalf an organization?

First Name*

Last Name*

Street Address Line 1*

Street Address Line 2 (optional)

City*

State*

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Zip Code*

Phone Number

(*required if an organization)

Email Address

(if available)

Primary Language in the household

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Does anyone in your household use assistive communication?

(i.e., hearing impaired needing closed captioning)

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Number of children at the home:

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Number of packets requested:*

Grade level of children

(enter all grade levels)

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Please send us your feedback to: Coloradoclassroom@rmpbs.org, or by calling 800-274-6666

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