Arts & Creativity Consultant Classroom Visit Request

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I would love to come to your school to observe a class and chat with you! I'm here to listen, share ideas, make connections, and support you. Heck, I'll even bring some chocolate! Fill out the form below if you would like me to drive the DPI "Family Truckster" to your school for a visit.

Educator First Name

Educator Last Name

Educator Email

Educator Cell Phone

Grade Levels You Teach

Undergrad or graduate

Adult

Art Discipline(s) You Teach

General Music

Vocal Music

Instrumental Music

Visual Arts

Media Arts

Theatre or Drama

Dance

Other:

What school would you like me to visit?

What is the name of your school district? *

School Address

Street Address, City, State, and Zip

What CESA area are you located in? *

Not sure? Click here to find out: https://www.cesa1.k12.wi.us/about/cesas_in_wisconsin.cfm

CESA 1

CESA 2

CESA 3

CESA 4

CESA 5

CESA 6

CESA 7

CESA 8

CESA 9

CESA 10

CESA 11

CESA 12

Best Times For A Visit

Check as many boxes as needed. If a specific class period goes past the hour just click the adjacent time block as well.

Prior to 8 am

8-9 am

9-10 am

10-11 am

11-Noon

Noon-1 pm

1-2 pm

2-3 pm

3-4 pm

Option 10

What class or classes would I be observing?

Example - 2nd hour or 3rd hour 7th grade Art

Any comments, requests, or specific directions?

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