Paint a Plow Program Application - Washtenaw County Road Commission

Date of Application*

Organization Name*

Organization Address*

Street Address Address Line 2 City

Contact Person's Name*

Contact Person's Email*

Contact Person's Phone*

Type of Organization*

All schools and community centers located in Washtenaw County are encouraged to apply.

Age of Particiapants*

Are you interested in receiving WCRC coloring books?*

Approx. how many coloring books do you need?*

Are you interested in having a WCRC employee talk with your students/participants about WCRC and the services we provide?*

We could customize our speaking program to fit the audience. Visit could be coordinated with plow pick-up or drop-off.

Does your organization allow participant's photos or video to be shared publicly?*

WCRC would like to share photos and video of students participating in the program if allowed by the school.

Program Guidelines*

I have read the program guidelines and I agree to follow all the stated rules. I am a qualified representative of the organization listed above.

Email

This field is for validation purposes and should be left unchanged.