var giftType = "One-time";
Outreach Program Request 2021-2022
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1.
Question - Required -
Your First and Last Name:
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2.
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Your Email Address:
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3.
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School Name:
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4.
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Grade Level:
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5.
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Is your school Title 1?
Please select response
Yes
No
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6.
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School Zip Code
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7.
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Students per Class:
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8.
Question - Required -
Are you interested in having monthly visits throughout the school year? (Monthly visits are available to grades 1-12).
Please select response
Yes
No
9.
Question - Not Required -
If not, please share desired number of visits and preferred schedule (weekly, bi-monthly, etc.)
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10.
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Preferred Day(s) of the Week:
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11.
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Preferred Start Time:
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12.
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Are you interested in having virtual or in-person visits?
Please select response
Virtual
In Person
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13.
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Please list the classes (including your own) you would like us to visit. Include the teachers' names, grades, and room numbers.
14.
Question - Not Required -
If you would like the lessons to coincide with your Character Trait lessons, please include the months and traits that you will be teaching. (ex. October - responsibility)
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15.
Question - Required -
School Address:
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16.
Question - Required -
Your Phone Number:
17.
Question - Not Required -
Please provide any additional information that is important for us to know about your class or school, including parking issues or school closure dates that would impact scheduling.
Spam Control Text:
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