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In-Person Museum on the Move Scheduling Form
2021-2022 School Year
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* Indicates required question
School Name
*
Your answer
School Address
*
Your answer
School Phone Number
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Your answer
Teacher First Name
*
Your answer
Teacher Last Name
*
Your answer
Teacher Email
*
Your answer
Person of Contact Email (if different from teacher email)
Your answer
Grade and Subject Area
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Your answer
Title(s) of Lesson(s) Desired
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Your answer
Date(s) Desired
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Your answer
Class Time(s)
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Your answer
Number of Students in Each Class
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Your answer
Technology Available (check all that apply)
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SMART Board
Projector
Promethean Board
Laptop/Computer
Screen/Chalkboard/Whiteboard
Required
What is the class currently studying or what will they be studying at the time of the lesson?
*
Your answer
Facebook Promotion: Do you grant permission for M&G Education Coordinator(s) to take a photo of the art activities (these would not include any students) for M&G to use on Facebook and other promotional materials?
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Yes
No
Facebook Promotion: Do you grant permission for M&G to mention on Facebook that we are coming to your school (before or after our visit)?
*
Yes
No
Additional Comments or Questions
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