Art in the Dark presentations are for students in Santa Clara County during the school year. Please fill out this registration form completely. You must have JavaScript enabled to use this form. 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? We are offering virtual and in-class options. Our ability to fulfill an in-class request is dependent upon current COVID conditions. Either Virtual or In-Person (this flexible choice can be guaranteed) Virtual Only (this choice can be guaranteed) In-Class Only (unable to guarantee, every attempt will be made to honor) What video conferencing platform are you using for distance learning? Google Meet Zoom Other platform: Other platform Does your school receive Title 1 funding? Yes No Number of classes Number of students in each class Number of virtual presentations (if you have an idea) 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 -N/AAncient CivilizationsAncient Civilizations (Two-part option)Ancient Civilizations (Three-part option)Middle Ages and the RenaissanceMiddle Ages and the Renaissance (Two-part option)Middle Ages and the Renaissance (Three-part option)Civil Rights in AmericaDiego Rivera and Frida KahloDiscovering Art Through Critical ThinkingSTEAM=STEM+ARTDigital Visual CommunicationDigital Visual Communication (Two-part option)Mexican Art and ActivismArt For You Select one. Request a Digital Presentation for Grades 9–12 - Select -N/ADiego Rivera and Frida KahloDiscovering Art Through Critical ThinkingSocial Documentary and Street PhotographyPhotography (Two-part option)Digital Visual CommunicationDigital Visual Communication (Two-part option)Mexican Art and ActivismCivil Rights in AmericaArt For You Select one. Month preferred for the presentation - None -JanuaryFebruaryMarchAprilMaySeptemberOctoberNovemberDecember 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? Have you received an Art in the Dark presentation before? Yes No How did you hear about the Art in the Dark program? LLAA email Program recommended by a colleague Other source: Other source
