Art in the Dark Presentation Request | San José Museum of Art

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

What is your preference for receiving the presentation?

Either Virtual or In-Person

Virtual Only

In-Class Only

Does your school receive Title 1 funding?

Yes

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

For virtual presentations, each teacher must host the video presentation and facilitate interactions with the students during the entire presentation. For in-person presentations, the teacher must remain in the classroom during the entire presentation and ensure good classroom behavior by the students, encouraging participation.

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

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?

Have you received an Art in the Dark presentation before?

Yes

How did you hear about the Art in the Dark program?

LLAA email

Program recommended by a colleague

Other source: