School Registration

Being a participating school with the Focus Program will enable your students to be actively involved in reducing the incidence of risky behaviors among their peers.

By completing this form, you will receive information and technical assistance for your school’s prevention efforts from the Focus Program director, Alabama Department of Public Health, and other community agencies.

School Name:
Facilitator’s Name:
Principal’s Name:
School Address:
City:
Zip:
Phone:
Fax:
Facilitator's Email Address:
Number of Focus Program Members:
Status:	Choose... New Member Current Member      Years:
Implemented As:	Choose... Extra-curricular Elective Class
As Part Of:	Choose... Health Science Family and Consumer Science Other      Name: