Similarity Awareness Request

Northeast Passage’s Similarity Awareness program explores the similarities we share regardless of ability, and celebrates the participation of individuals of all abilities in sport.

Please complete this form to request a presentation. We will confirm your date and time and we're happy to work with you to make modifications as needed. Thank you for your interest!

School or Organization Name:

Name & Title of Person Completing this form:

Billing Contact (please include name and email address):

Email of person completing this form:

Location of program (including address):

Date preference:

Secondary date(s):

Number of days:

Program time preference:

Secondary time preference:

Is there flexibility with proposed dates and times?

Grade(s):

Number of Classes:

Total number of students with disabilities:

Total number of students:

Day of presentation contact name:

Day of contact phone number and email address:

PROGRAM INFORMATION:

Unloading/Parking Instructions:

For multi-day programs, can NEP leave a trailer overnight?

For multi-day programs, is there a secure place to leave equipment overnight?

Check-In Process at School:

Please provide detailed information on the following for all program days:
• Class schedule (including start/end time and breaks)
• Number of times classes will repeat for multi day program
• Number of students per class
• Grades per class
• Disability specifics per class (including # of students with a disability and type of disabilities)
• If NEP is already familiar with specific student needs please provide names

Please upload class schedule:

Additional Comments:

Contact Information