Program Profile Form

2024 - 2025 School Year Signup

Please use the form below to sign up. Fields marked with * are required.

Reading Program Renewals: Reminder, if have not yet completed your 2023 - 2024 survey, that will need to be completed in order to be eligible for your 2024 - 2025 book shipments. Please contact Janet Kassoff (Ohio) or Sara Boyden (outside Ohio) for the link to submit your renewal form.

New Programs: Please submit this form to get set up for book shipments. An end of the year, you will receive a survey to summarize your efforts.

New Program Information

Program Name (School District / Main School Name)

Please enter a valid program name.

Type

Please select a valid type.

Main Address

Please enter a valid address.

County

Please enter a valid county.

City

Please enter a valid city.

State

Please select a valid state.

Zip

Please enter a valid zip code.

Contacts

Address for Book Shipments

Attention (Optional)

Attention Line 2 (Optional)

Shipping Address

Please enter a valid address.

Address 2

City

Please enter a valid city.

State

Please select a valid state.

Zip

Please enter a valid zip code.

Elementary Schools

Please list all elementary school(s) that will receive 2nd & 7 reading visits this year:

Additional Program Information

Name of high school/college/university providing positive role models to read with 2nd grade students:

Please enter an answer.

Please list all specific teams that will serve as volunteers (i.e. football, women’s volleyball, cheerleading, etc.):

Estimated number of athlete reading volunteers:

Please enter an answer.

Estimated total number of 2nd graders you will visit this year:

Please enter an answer.

Number of reading visits you will have with EACH 2nd grader:

If visiting more than 1 time with each 2nd grader, please indicate how many Hog Mollies titles you will need.

Please select an answer.

Please list your anticipated reading visit date(s) if already scheduled:

Please share your social media handles so we can follow your team and school

Be sure to follow us social media too!