Chicago 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

No

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 August 27, 2012 through November 11, 2012 at the following times:

Monday	Tuesday	Wednesday	Thursday
9:00-10:30am	9:00-10:30am	9:00-10:30am	9:00-10:30am
11:00-12:30pm	11:00-12:30pm	11:00-12:30pm	11:00-12:30pm

We can also arrange tours on selected Saturdays and after hours. Please indicate a specific date and time preference, and we will do our best to accommodate your needs:

First choice:

First Choice Date:

Second choice:

Second Choice Date:

Third choice:

Third Choice Date:

If you have any questions please contact andie_thomalla@facing.org [1] Or visit www.choosingtoparticipate.org [2].

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