JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Buffalo Soldiers National Museum In-School Program
Logistics Questionnaire
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of School/Organization
Your answer
School/Organization Address
Your answer
Requestor's Name
Your answer
Requestor's Position
Your answer
Requestor's Contact Number
Your answer
Requestor's Email Address
Your answer
If the individual requesting our services will not be present during our visit, please provide the following information for our staff member who will be present during our sessions with the students:
Point of Contact
Point of Contact Number
Point of Contact Email
Your answer
How did you hear about the Buffalo Soldiers National Museum?
(Please check all that apply)
Museum Field Trip
Email
Resource Outreach Event
Professional Development Workshop
BSNM Newsletter
BSNM Website
Other:
Will our educator(s) have access to electronic equipment during the program?
Yes
No
Clear selection
Computer?
Yes
No
Clear selection
Screen?
Yes
No
Clear selection
Projector?
Yes
No
Clear selection
Speakers?
Yes
No
Clear selection
Internet?
Yes
No
Clear selection
Date of Scheduled Program
MM
/
DD
/
YYYY
Start Time of Scheduled Program
Time
:
AM
PM
Total Number of Sessions/Class Periods
Your answer
Length of Each Session
Your answer
Average Number of Students in Each Session
Your answer
Total Number of Students
Your answer
Grade Level(s) of Students
Your answer
Type of Organzation
Public
Private
Charter
Religious
Home School
College/University
Community Organization
Adult Learning
Other:
Clear selection
Demographic Composition of Students/Participants (total number)
Your answer
Please describe the level of knowledge the participants have on the topic. What resources have the participants used to learn about the selected topic (e.g. books, movies, documentaries, etc.)?
Your answer
Is there any information you would like the educator to know regarding your classroom, students, participants, school, and/or organization?
Your answer
How will the teacher(s) and/or staff be actively involved in creating a safe, respectful, and enriching learning environment for the participants?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Buffalo Soldiers National Museum.
Report Abuse
Forms
