Request Copies of Rosa Parks YA Book
Complete the form below to be considered to receive five copies of the young readers' book, "The Rebellious Life of Mrs. Rosa Parks."

UPDATE: We have far exceeded 14 requests. If you complete the form, we will place you on a waiting list in case more funds become available.
Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Email address *
School *
Role, subject, and grade level. *
City *
State *
How will you use the books?
Offer a description (one or two paragraphs) of how you will use these books in your curriculum this year.
How will you share feedback on the book?
To help spread the word about the book, we ask recipients to plan to give it visibility. Share here how you might do that. It could be sharing a photo of students with the book on social media, asking students to write reviews for Goodreads or other book platforms, student created social media promotions for the book, or other ideas you have.
Mailing address *
If you are selected to receive the set of books, where would we send them?
Questions or comments.
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
Google Forms