Poetry in America Group Enrollment Interest Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please provide your school's information below if your school is interested in enrolling a group of students in Poetry in America: The City from Whitman to Hip Hop for the Fall 2020 semester.

Email *

School Name(s). If entering more than one school name, please separate school names with a comma. *

If you are a school district representative, please provide the name of your district below.

Your First Name *

Your Last Name *

Your email address *

Your job title *

Are you planning to be the Site Coordinator with your school? If not, please select "Other" and include the Site Coordinator's name and email below. *

(NOTE: The Site Coordinator will work with the course administration team to help ensure smooth operation of the program for all participating teachers and students. Supervising Teachers may also serve as Site Coordinators, but we recommend selecting an administrator who can provide additional support.)

Yes

Other:

Is your school a Title I school? *

Yes

My school is Title I-eligible, but is not currently registered as a Title I school

I am registering multiple schools, some of which are Title I schools and some of which are not

The cost per student is $250. How will your group cover student enrollment costs? *

School will provide funding

District will provide funding

Community partner will provide funding

Unsure

Other:

How many spots would you like us to hold for your students? *

We recommend ~20 students per class period.

Do your students receive school-issued devices that they can take home (tablets, laptops, etc.)? *

Yes

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of poetryinamerica.org. Report Abuse

Forms