Scheduling Site Visits Form

Thank you for your interest in scheduling a site visit with Reach Out & Read Illinois, currently we are only accepting visits in a virtual format. If this does not work for you, please feel free to reach out to us via email (oheinzeroth@illinoisaap.com).

Name (First Last)

Site Name

If you are the site coordinator for multiple sites, you can list several here or complete the form multiple times.

Date Option #1

Please select dates during the months of July, August, or September. Site visits should take 45 minutes.

mm/dd/yyyy

Date Option #2

Please select dates during the months of July, August, or September. Site visits should take 45 minutes.

mm/dd/yyyy

Date Option #3

Please select dates during the months of July, August, or September. Site visits should take 45 minutes.

mm/dd/yyyy

Time of day

Should anyone else be informed about this meeting? Please include their names, roles, and emails.

Consider your supervisor, primary site contacts, and other hospital network individuals.

Send me a copy of my responses

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