Helping Fit Pieces Together Material Request Form

Contact Information

1. Name *This question is required.

2. Email address: *This question is required. This question requires a valid email address.

3. Phone Number: *This question is required.

4. TriKappa Chapter and Role:

Shipment Information

5. Shipment Address: *This question is required.

6. Date When Needed (please allow 2-3 weeks): *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

Event Information:

7. Event Name and Location: *This question is required.

8. Date of Event *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

9. Target Audience and Expected Number of Attendees *This question is required.

11. Materials Requested (enter quantity):
* Estimated assembly time is based on 1-2 people assembling one set of the project

Space Cell	Sets In English	Sets In Spanish
Autism Information Cards - People With ASD May (red card) (25 Finished cards per set) Set Assembly takes approximately 10-15	Autism Information Cards - People With ASD May (red card)(25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In English	Autism Information Cards - People With ASD May (red card)(25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In Spanish
Autism Information Cards - This Individual Has Autism (blue card) (25 Finished cards per set) Set Assembly takes approximately 10-15	Autism Information Cards - This Individual Has Autism (blue card) (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In English	Autism Information Cards - This Individual Has Autism (blue card) (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In Spanish
Autism Information Cards - I Have Autism (green card) (25 Finished cards per set) Set Assembly takes approximately 10-15	Autism Information Cards - I Have Autism (green card) (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In English	Autism Information Cards - I Have Autism (green card) (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In Spanish
Non-Key Provider Information Lanyards (1 Finished card/lanyard per set) Set Assembly takes approximately 5-10 minutes	Non-Key Provider Information Lanyards (1 Finished card/lanyard per set) Set Assembly takes approximately 5-10 minutes : Sets In English	Non-Key Provider Information Lanyards (1 Finished card/lanyard per set) Set Assembly takes approximately 5-10 minutes : Sets In Spanish
My Friend with Autism Bookmark (25 Finished cards per set) Set Assembly takes approximately 10-15	My Friend with Autism Bookmark (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In English	My Friend with Autism Bookmark (25 Finished cards per set) Set Assembly takes approximately 10-15 : Sets In Spanish
My Turn/Your Turn Cards (6 finished cards per set) Set Assembly takes approximately 10 minutes	My Turn/Your Turn Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes : Sets In English	My Turn/Your Turn Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes : Sets In Spanish
Stop/Go Cards (6 finished cards per set) Set Assembly takes approximately 10 minutes	Stop/Go Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes : Sets In English	Stop/Go Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes : Sets In Spanish
Go/Wait Cards (6 finished cards per set) Set Assembly takes approximately 10 minutes	Go/Wait Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes: Sets In English	Go/Wait Cards(6 finished cards per set) Set Assembly takes approximately 10 minutes: Sets In Spanish
**********************************************************	**********************************************************: Sets In English	**********************************************************: Sets In Spanish
(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Stoplight and Countdown Boards (large) (1 finished Stoplight and 1 finished countdown per "set") Set Assembly takes approximately 10-15 minutes	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Stoplight and Countdown Boards (large)(1 finished Stoplight and 1 finished countdown per "set") Set Assembly takes approximately 10-15 minutes : Sets In English	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Stoplight and Countdown Boards (large)(1 finished Stoplight and 1 finished countdown per "set") Set Assembly takes approximately 10-15 minutes : Sets In Spanish
(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Mini Stoplight, Countdown, and First-Then Boards on a Pulley (1 finished pulley per "set") Set Assembly takes approximately 15-20 minutes	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Mini Stoplight, Countdown, and First-Then Boards on a Pulley(1 finished pulley per "set") Set Assembly takes approximately 15-20 minutes : Sets In English	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Mini Stoplight, Countdown, and First-Then Boards on a Pulley(1 finished pulley per "set") Set Assembly takes approximately 15-20 minutes : Sets In Spanish
(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Functional Communication Pulley Cards:	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Functional Communication Pulley Cards:: Sets In English	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Functional Communication Pulley Cards:: Sets In Spanish
(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS) Social Communication Pulley Cards	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS)Social Communication Pulley Cards: Sets In English	(PREVIOUS PROJECT - NOT CURRENTLY ACCEPTING MATERIALS REQUESTS)Social Communication Pulley Cards: Sets In Spanish