Quality of Life INNOVATIONS Registration

Thank you for your interest in the Quality of Life INNOVATIONS program. TO REGISTER, please complete the form below. The Senior Program Manager will reach out to schedule an initial meeting with the teacher coordinator to ensure you have access to the QLI resources and have support getting the program started at your school. If you encounter any technical difficulty or have any questions, please email Josiah Williams at jwilliams@wise-ny.org or 347-222-3636.

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Company
This field is for validation purposes and should be left unchanged.
School Name*
School Address*
Street Address Address Line 2 City State ZIP Code
School Phone Number*
Number of Participating Students (Anticipated)*
School Coordinator Name**
First Last
*The school coordinator is the supervising teacher for the program at your school.
School Coordinator Email*
School Coordinator Discipline*
School Coordinator Cell Phone Number*
If you will have more than one QLI teacher, please list their name and email address
Principal or Department Head Name*
First Last
Principal or Department Head Email*
Principal or Department Head Phone Number and Extension*
School Treasurer/Financial Officer Name*
First Last
School Treasurer/Financial Officer Email*
Participation Approval*
- The participation of my school has been approved by the school's principal or department head and we agree to pay the participation fee.