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Thank you for your interest in the ASPIRE program! Please complete the following questionnaire and an ASPIRE coordinator will contact you within 1-2 business days.

What is the name of your school/organization?

What is the name of your school district? (Please type N/A if not applicable)

Please enter your organization's website.

What is your first and last name?

What is your title?

Please list your email address so that the ASPIRE team can contact you.

Please list a phone number where the ASPIRE team can reach you.

What city is your school/organization located in?

What state is your school/organization located in?

What county is your school/organization located in?

What is the zip code of your school/organization?

How do you plan to implement ASPIRE?
Please note, ASPIRE was not created for use with students caught violating tobacco/vaping campus policies or laws.

Incorporate into an existing class/curriculum (i.e. health, science, technology)
Ancillary period
Include for an open period (homeroom, study hall, etc.)
Other

Please provide an estimate of the number of students who will participate in ASPIRE.

Requested services (select all that apply):

Schedule an ASPIRE informational call with an ASPIRE coordinator
Enroll a school/organization in ASPIRE (please specify below whether ASPIRE will be implemented at a school or district wide level)
Request a virtual presentation on the harms of tobacco and vaping (Texas only)
Schedule an instructional training for educators currently using ASPIRE
Access to an unlocked student test account to preview ASPIRE
Extend an invitation to participate in a health fair (Only available to schools in Houston MSA)
Other:

How did you hear about ASPIRE?

Internet search
Presentation, conference, etc...
Another school/ organization (please specify):
Other (please specify):