Contact name Position with school E-mail address

E-mail is our primary means of contact; please provide an account that is frequently checked.

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School name City State Principal Office phone

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Safe Routes to School assemblies are tailored to the size of the audience. Please be as accurate as possible in the details below. Our materials provided are based on the number of participants given.

Type of assembly requested Pedestrian Safety Bicycle Safety Both Total number of students attending Type of assembly space (Classroom setting preferred) Classroom Auditorium Stage Other If Other, please specify: Capacity of assembly space Preferred date Preferred time Any timeMorningAfternoon Will you allow media coverage at this event? Yes   No

Send this information

Thank you for requesting a Safe Routes to School assembly at your school designed to elementary and middle school aged children pedestrian and bicycle safety. The Mississippi State Department of Health's Safe Routes to School office will contact you within one week of receipt of your application to schedule a program.