Gluck Fellows Request Form 2017-2018
Site Coordinators, please submit one form per Fellow requested. List all teachers/hosts who would like this Fellow to come to their classes at your school/site. Separate requests for the same Fellow from multiple teachers/hosts will not be scheduled as quickly as a complete single request listing all teachers interested.

Requests for several back-to-back sessions on one day for multiple classes have higher priority than requests for a single session. Confirmation of Fellow presentations and all questions will go through the established Gluck Site Coordinator.
Register your interest for a Fellow with this form, and we will contact you when the Fellow is available.

Are you NEW to Gluck? Please contact the Gluck Office to set up your site - all sites must be within 20 minutes drive of UCR. Email us at gluckprogram.ucr@gmail.com to set up your site!

Fellow/Ensemble Requested
Your answer
Name of School/Site
Your answer
Grade level(s) Requested
If you are not a school, please let us know if it is Family Learning or adults, etc...
Your answer
How Many Sessions Requested?
If we could fulfill your request completely, how many sessions would you like?
Your answer
Dates / Days of Week Requested?
List as many dates/days as possible to increase chances for scheduling (eg 'any Monday in October' or 'MWF except: ...') If Fellow has not yet provided their availability, we will contact you directly when available dates are known.
Your answer
Times Possible?
List as many times as possible, or a range, to increase chances for scheduling. Please let us know about recess, lunch times.
Your answer
Last Names of Teachers Requesting the Fellow
Please give the last names of the teachers who would host the Fellow in their classroom. (eg. Smith, Jones, Bojangles)
Your answer
Notes for Scheduling
Include any information or special needs to help us schedule the Fellow (eg. SDC; 1st class will have recess in the middle; can use MPR; no projector in room, must finish by noon, 3 in one day...)
Your answer
Submit
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