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 *

Alternate 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? Please tell us a little bit about them, including 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.