Well Badger Resource Center

Thank you for sharing your information with the Well Badger Resource Center database.

IMPORTANT: Please review the Submission Form Instructions (found here) and Inclusion Criteria (found here) prior to completing this form. If you have multiple programs or sites to list please contact us at agencyinfo@wellbadger.org

A few tips for completing this Submission Form:

Please use the next and back buttons to navigate.
If you aren’t sure what to enter for a certain question, you can leave it blank.
Click all the way through to the end of the survey until you reach the message “Thank you for your submission!”
A Well Badger Resource Specialist will contact you within two weeks if we need clarification or additional information.

First, tell us about yourself. *This question is required.

First Name

Last Name

Title

Email Address

Phone Number
Ex: 123-123-1234, ext. 123

Well Badger Resource Center - Submission Form