Request a Art in the Dark Presentation

Name of contact person *

Title or role *

(Teacher, School Secretary, PTA representative, etc.)

Work email *

Alternate email

School phone number plus extension *

Preferred phone number

School name *

School district *

School address *

Does your school receive Title 1 funding? *

Yes

No

Number of classes *

Number of students in each class *

Are you requesting the program for semester class(es)? *

Please list all participating teacher’s names, and email addresses *

Teachers’ subject area *

Grade level(s) *

Request a Digital Presentation for Grades 6–8 *

Select one.

Request a Digital Presentation for Grades 9–12 *

Select one.

Month preferred for the presentation

Select one. Program dates are September – May.

Are any of the classes designated as Special Day Classes (SDC) *

Yes

No

If you have any special needs students, how many ARE in each class? In order to give your class the best experience, please tell what accommodations your special needs students require from guest speakers. Please also include the number of aides who will attend the presentation. (Otherwise put N/A). *

Is there anything else you would like to tell us about your group? *

Would you like to receive emails about events, exhibitions, and other programs from SJMA? *

Yes

No

By providing your email address you opt in to receive regular emails from SJMA.

Have you received an Art in the Dark presentation before? *

Yes

No

How did you hear about the Let’s Look at Art program? *

LLAA email

Program recommended by a colleague

Other source:

Other

Art in the Dark Presentation Request

Please fill out this registration form completely.