Spring 2025 Application

Please note if we are able to accommodate your district, you will receive a confirmation email. For additional information and video footage of the full scale mock crash please visit our website!
Thank you!

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* 1. School District Name:

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* 2. School contact person name:

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* 3. Contact person phone number:

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* 4. Contact's email address:

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* 5. Have you ever worked with Upstate Trauma to conduct Let's Not Meet By Accident in the past?

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* 6. If so, what year was this last conducted?

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* 7. Does your district currently or in the past conduct a mock DWI or full scale crash with students and first responders?

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* 8. If so, please describe the details of this previous mock crash and state the community partners involved:

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* 9. Please select which Let's Not Meet By Accident pathway you're requesting:

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* 10. If you selected the full scale mock crash, will you agree to a maximum of 3 virtual or in-person planning meetings?

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* 11. I understand that it is the school districts responsibility to lead coordination efforts with their local fire, police, ems etc.

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* 12. As a district you will assume the responsibility of obtaining parental permission for those participating whether as victims or viewers.

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* 13. If you selected the full scale mock crash, do you have an auditorium/gymnasium or large cafeteria area this can be conducted with AV equipment?

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* 14. Please state the approximate number of students you expect to attend:

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* 15. What grade levels do you wish to have participate in the presentation/mock crash?

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* 16. Any further comments or special requests?

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