KIP Survey Return Form 2018

This form will provide REACH with the information needed to make shipping arrangements for the return of KIP surveys completed by your school district. Please be sure to accurately complete all the requested information, including the exact box dimensions (length x width x height), the weight of each box, the exact shipping address (building name, street address, city, state and zip code), and your phone number should we have any questions. Include any specific pick-up instructions, (e.g. "pick up from back door of middle school").

Shipping arrangements will be made within three (3) business days upon receipt of your form. If you do not receive e-mailed shipping labels and instructions within this time frame, contact us at 502.585.1911.

1. CONTACT INFORMATION:

Survey Coordinator

School District

Phone Number

Email Address

2. PICK-UP ADDRESS:

Name of building (i.e. school name)

Street Address

City

State

Zip

3. Include any specific pick-up instructions here, (e.g. "pick up from back door of middle school"):

4. DESCRIPTION OF BOXES

Space Cell	Weight (pounds)	Dimensions (Length)	Dimensions (Width)	Dimensions (Height)
Box #1	Box #1: Weight (pounds)	Box #1: Dimensions (Length)	Box #1: Dimensions (Width)	Box #1: Dimensions (Height)
Box #2	Box #2: Weight (pounds)	Box #2: Dimensions (Length)	Box #2: Dimensions (Width)	Box #2: Dimensions (Height)
Box #3	Box #3: Weight (pounds)	Box #3: Dimensions (Length)	Box #3: Dimensions (Width)	Box #3: Dimensions (Height)
Box #4	Box #4: Weight (pounds)	Box #4: Dimensions (Length)	Box #4: Dimensions (Width)	Box #4: Dimensions (Height)
Box #5	Box #5: Weight (pounds)	Box #5: Dimensions (Length)	Box #5: Dimensions (Width)	Box #5: Dimensions (Height)
Box #6	Box #6: Weight (pounds)	Box #6: Dimensions (Length)	Box #6: Dimensions (Width)	Box #6: Dimensions (Height)
Box #7	Box #7: Weight (pounds)	Box #7: Dimensions (Length)	Box #7: Dimensions (Width)	Box #7: Dimensions (Height)
Box #8	Box #8: Weight (pounds)	Box #8: Dimensions (Length)	Box #8: Dimensions (Width)	Box #8: Dimensions (Height)
Box #9	Box #9: Weight (pounds)	Box #9: Dimensions (Length)	Box #9: Dimensions (Width)	Box #9: Dimensions (Height)
Box #10	Box #10: Weight (pounds)	Box #10: Dimensions (Length)	Box #10: Dimensions (Width)	Box #10: Dimensions (Height)
Box #11	Box #11: Weight (pounds)	Box #11: Dimensions (Length)	Box #11: Dimensions (Width)	Box #11: Dimensions (Height)
Box #12	Box #12: Weight (pounds)	Box #12: Dimensions (Length)	Box #12: Dimensions (Width)	Box #12: Dimensions (Height)
Box #13	Box #13: Weight (pounds)	Box #13: Dimensions (Length)	Box #13: Dimensions (Width)	Box #13: Dimensions (Height)
Box #14	Box #14: Weight (pounds)	Box #14: Dimensions (Length)	Box #14: Dimensions (Width)	Box #14: Dimensions (Height)
Box #15	Box #15: Weight (pounds)	Box #15: Dimensions (Length)	Box #15: Dimensions (Width)	Box #15: Dimensions (Height)
Box #16	Box #16: Weight (pounds)	Box #16: Dimensions (Length)	Box #16: Dimensions (Width)	Box #16: Dimensions (Height)
Box #17	Box #17: Weight (pounds)	Box #17: Dimensions (Length)	Box #17: Dimensions (Width)	Box #17: Dimensions (Height)
Box #18	Box #18: Weight (pounds)	Box #18: Dimensions (Length)	Box #18: Dimensions (Width)	Box #18: Dimensions (Height)
Box #19	Box #19: Weight (pounds)	Box #19: Dimensions (Length)	Box #19: Dimensions (Width)	Box #19: Dimensions (Height)
Box #20	Box #20: Weight (pounds)	Box #20: Dimensions (Length)	Box #20: Dimensions (Width)	Box #20: Dimensions (Height)