LAPD/CSP and Rocket team up for an  interactive classroom presentation!
* Large Assemblies NOT recommended. 
* 50-60 students MAX per presentation.
Sign in to Google to save your progress. Learn more
Email *
Officer and School Contact Information
Will there be an officer present for the lesson? *
If YES, provide Officer Name. 
If NO, type "N/A".
 *
If YES, provide Officer Email Address.
If NO, type "N/A".
 *
If YES, provide Officer Phone Number.
If NO, type "N/A".
 *
Are you a CSP Officer? *
School Name *
Is this an LAUSD school? *
School Address *
School Phone Number *
School Contact Title/Position *
School Contact Email Address *
School Contact Phone Number *
Is this your first ROCKETLive! Presentation? *
Grade Level *
Large Assemblies NOT recommended  
* 50-60 students MAX per session

Number of 20-minute Sessions on Presentation Day
 *
Total Number of Students *
These are the RocketLive! Lessons offered.
Please choose one lesson for your ROCKETLive! session.
* All classes will receive the same lesson. 
Which lesson do you prefer? *
Please request 2 dates for your presentation. 
*Once your request is submitted, the date and time will be confirmed within 48 hours.
1st Date Choice
 *
MM
/
DD
/
YYYY
1st Time Choice *
Time
:
2nd Date Choice *
MM
/
DD
/
YYYY
2nd Time Choice *
Time
:
Please list any additional accommodations needed for the classroom: (e.g. special education, bilingual Spanish lesson, etc.)
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Rocketlive.

Does this form look suspicious? Report

Google Forms