What is your program ID?

This number was provided in the enrollment invitation sent to you from info@okleadtesting.org. If you are unsure of your program ID, please call our program team at (405) 440-3180 or leave this question blank. 

What is the name of your school or child care?

Which of the following best describes the facility?

Public School

Licensed Child Care Program

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Facility Address

What is the physical address of your school or child care?

County

Please select a county. Adair Alfalfa Atoka Beaver Beckham Blaine Bryan Caddo Canadian Carter Cherokee Choctaw Cimarron Cleveland Coal Comanche Cotton Craig Creek Custer Delaware Dewey Ellis Garfield Garvin Grady Grant Greer Harmon Harper Haskell Hughes Jackson Jefferson Johnston Kay Kingfisher Kiowa Latimer LeFlore Lincoln Logan Love Major Marshall Mayes McClain McCurtain McIntosh Murray Muskogee Noble Nowata Okfuskee Oklahoma Okmulgee Osage Ottawa Pawnee Payne Pittsburg Pontotoc Pottawatomie Pushmataha Roger Mills Rogers Seminole Sequoyah Stephens Texas Tillman Tulsa Wagoner Washington Washita Woods Woodward

City

Zip Code

Is your mailing address different from the school or child care's physical address?

Yes

No

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Please provide contact information for the primary person of contact:

First Name

Last Name

Phone

Format: +11234567890 or 405-123-4567

Email

Would you like to include anyone else in program email communications?

If yes, please enter their emails below, separated by commas.

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What is the estimated number of drinking water outlets at the school or child care?

Drinking water outlets include drinking fountains, classroom faucets, kitchen faucets, bathroom faucets or other water sources that could be used for cooking or drinking. 

What are your school or child care's typical hours of operation?

The US Environmental Protection Agency states that participants of the LWSC Program should publicly post sampling results for community members (parents/guardians/staff) to access. Additionally, all sampling results will be made available to the public via the DEQ’s website.

I acknowledge the importance of make sampling results accessible to the community. I also acknowledge that all results will be posted on DEQ’s public facing website.

Yes, I acknowledge this and would like to proceed with my enrollment.

No, I do not acknowledge this and would like to cancel my enrollment.

How did you hear about the Oklahoma Lead Testing Program?

Lead Testing Program emails / phone calls

Department of Environmental Quality (DEQ)

Word of mouth

Other

How did you hear about the Oklahoma Lead Testing Program? - Other

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