The Dewitt Center Program Intake Form
Please answer the questions below about your program at The Dewitt Center.
If you have any questions regarding The Dewitt Center please contact Lyndon Vincent at
lvincent@madison-park.org
.
Contact Name
Email
Organization/Sponsor Name
Program Name
Program/Organization Website
Program Age Range
School Age (5-12)
Youth/Teens (13-20)
Adults (21+)
Seniors (60+)
Date/Time(s) of Program
Program Description for The Dewitt Center Catalog
Will you be promoting this program? If yes, where/how?
The Dewitt Center has my logos and marketing materials
Yes
No
Please upload your logo here
Please upload your marketing materials here
Contact Information