Classroom Workshop Request Form
Email address *
Contact Information
First Name *
Your answer
Last Name *
Your answer
Name of School or Organization *
Your answer
Type of Organization *
Address *
Your answer
Phone Number *
Your answer
Best Time to Contact You
Preferred Method of Contact
Desired Date/Time of Program
The Kiva Center generally conducts School Outreach programs on Mondays, Tuesdays, and Fridays. We will most likely be able to accommodate program requests that fall on those days.
List 3 Desired Program Dates in Order of Preference *
Your answer
Start time of program *
Time
:
End time of program *
Time
:
Program Topic
The Kiva Center offers the following pre-designed workshops AND works to tailor program topics to fit your specific needs. Please indicate which of the following workshops you would like to schedule. If you prefer the topic to be uniquely tailored to your classroom, indicate the category that you wish to explore.
Workshop Topics *
Other Categories (for individually-tailored workshop)
Is there a specific reason why your group is requesting a workshop from The Kiva Center? (such as teaching unit, community project, etc.)
Your answer
Participant Information
Age of Participants *
Your answer
Number of Participants *
Your answer
Preferred Language *
How did you hear about The Kiva Center's School Outreach Program? *
Any additional information that we should know:
Your answer
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