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Tour Request Form

Teacher Name:

School Name:

School Address:

School City:

School State:

School Zip Code:

School Phone:

Home Phone:

Your Email Address:

Best time and way to reach you:

# of students attending:

Grades:

This exhibition is intended for students in grades 6-12

# of chaperones:

minimum of 1 per 15 students

Total:

maximum of 80 people per time slot

Do any of your students have any special needs in which they will require assistance? If so, please explain::

We strongly encourage you to prepare your students before the exhibition.

Would you like a Facing History Program Associate to contact you regarding appropriate materials for use in the classroom?:

Yes

Please indicate your date and time preference below. Although we would like to give all groups their first choice, it is not always possible. Request forms are processed in the order in which they are received and according to availability. You will receive email confirmation of your scheduled date and time.

Guided tours are available starting January 31, 2011 through June 16, 2011 at the following times:

Tuesday	Wednesday	Thursday	Friday
10:00-11:30am	10:00-11:30am	10:00-11:30am	10:00-11:30am
12:30-2:00pm	12:30-2:00pm	12:30-2:00pm	12:30-2:00pm
3:00pm-4:30pm	3:00pm-4:30pm	3:00pm-4:30pm	3:00pm-4:30pm

First choice:

First Choice Date:

Second choice:

Second Choice Date:

Third choice:

Third Choice Date:

More options:

YES, I would like to apply for funding for transportation. (Facing History has limited funds available for this purpose.)

If you have any questions please contact lindsay_bowles@facing.org Or visit www.choosingtoparticipate.org.

Please feel free to photocopy this form to share with your colleages!

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Tour Request Form

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