January 31 - March 29, 2023- Art+(Re)Telling
April 4 - May 31 - Art+Story
* This program will run Tuesdays and Wednesdays
Date of Requested School Visit
2nd / 3rd Options if requested date is unavailable
2nd - Date of Requested School Visit
3rd - Date of Requested School Visit
Time of Requested School Visit (all times are PST)
I understand that this is a timed program and commit to arrive by 9:00 am. If you cannot attend, please cancel 48 hours in advance
Is this your first time participating in the program or are you a returning class?
If returning, how many years have you participated?
Lead Teacher's First Name
Lead Teacher's Last Name
Lead Teacher's Email Address
Contact Phone Number
School Zip Code
School Phone Number
TItle I School?
How will you be arriving
Applying for bus scholarship (only applicable for schools within a 10-mile radius)
Which program are you selecting?
Art+(Re) Telling (7th - 12th)
Art+Story (3rd - 6th)
Number of Teachers and Chaperones
Please enter information one grade level at a time. If you need to add an additional grade level then please click on the link "Add another response" on the bottom right. When complete please click Next Page to continue.
Number of Students
Student Grade Level
Do you have any ESL students?
Do you have any students that need special accommodations?
Please describe the accommodations needed
Please provide additional information about your class, including anything that will help support the lessons you plan on providing them in relation to your visit.