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Bishop Dunn Memorial School Program Request Form
Please complete this form at least two weeks before the start date of your program. BDMS will create and distribute the information to parents if necessary.
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* Indicates required question
Email
*
Your email
Faculty Member
*
Your answer
During School or After School Program?
*
Between the hours of 8:00AM and 2:30PM
Between the hours of 2:45PM and 6:30PM
Room/Location Requested (Some spaces may be unavailable for whole class fieldwork)
*
Choose
Classroom
Art Room
Gymnasium
Other
Course Number
Your answer
Title of Program
*
Your answer
Content Area
*
Your answer
Grade Levels
*
PreK
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Required
Number of Students Requested
*
0-5
5-10
10-15
15-20
Entire Class
Other
Required
Date Program Begins
*
MM
/
DD
/
YYYY
Date Program Concludes
*
MM
/
DD
/
YYYY
Day (s) of Program
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Time Program Begins at Bishop Dunn
*
Time
:
AM
PM
Time Program Ends at Bishop Dunn
*
Time
:
AM
PM
Intended Goal (s)
*
Your answer
Additional Pertinent Information (can be pasted from prior documents).
Your answer
Is Parent Consent Needed for Participation?
*
Yes
No
What is the Materials fee, if any? If none, leave blank.
Your answer
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