JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Virtual Classroom/Club Visit Request Form
Use this form to request virtual classroom and club visits.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
E-mail address
*
Your answer
Mobile phone number at which you can be reached:
*
Your answer
School or Institution
*
Your answer
Class or club for which you are interested in having a virtual visit
*
Your answer
Topic or theme for which you are interested in having a virtual visit (check all that apply):
*
Cultural Expectations
What's in a Name?
Migration and Diaspora
Geopolitics
Science and Technology in a Global Context
Foodways and Colonialism
Other
Required
If you selected "other" above, in which topic or theme are you interested in having a virtual visit?
Your answer
Online platform which your school is using this year:
*
Microsoft Teams
Schoology
Zoom
Google Classroom
YouTube Live
Facebook Live
Other
Required
In which format are you interested in having the virtual visit?
Pre-recorded activity
Livestream visit
If you are interested in the livestream option, please indicate the day of the week (or actual date) and time, including time zone.
Your answer
Venue for which you are interested in having a virtual visit:
*
Student club
After school care program/camp
Classroom
Other:
Required
Are you interested in having a presentation in another language?
No
Yes
If you are are interested in having a presentation in another language, please indicate which language.
Your answer
Are you interested in having a particular UCIS unit provide the presentation for your virtual visit?
*
Yes
No
Not sure
If you are interested in having a particular UCIS unit provide the presentation for your virtual visit, please indicate which unit:
African Studies Program
Asian Studies Program
Center for Latin American Studies
Center for Russian, East European and Eurasian Studies
European Studies Center
Global Studies Center
Nationality Rooms and Intercultural Exchange Programs
Clear selection
Are you amenable to having a Pitt graduate or undergraduate student virtually present to your students?
*
Yes
No
Maybe
Is there anything else you would like to share with us?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
