School Programs Registration – History San Jose

Today's Date *

Enter today's date (e.g. July 18, 2020)

Contact Name *

First

Last

Contact Phone (include area code) *

Contact Email *

Confirm Email

School Name *

If you are part of a homeschool group or other type of organized group, please complete this section with contact's address.

School District *

If not in a school district, please write N/A

School Address *

Street address

School Address (Line 2)

School City *

School State *

School Zip Code *

School Phone (include area code) *

Is your school Title I? *

You are eligible to receive a grant that would cover your program fees and up to $300 in transportation expenses.

Grade Level(s) *

Non-school groups, please write N/A

Number of students *

Number of teachers *

Number of chaperones *

Type of Program *

Programs offered will run from September 20, 2021-June 3, 2021

Program Setting *

Please indicate if you are teaching online, in the classroom, or in a hybrid setting. We will approach student engagement based on their circumstances.

Program Name (select one) *

First Choice Date *

Enter as MM/DD/YYYY

First Choice Time *

Times are in Pacific Standard/Daylight Time. The hours that are 10 past the hour are for virtual field trips. The 9:30 am start times are for all onsite school programs and the 11:00 am is only for the onsite Early to Rise program.

Second Choice Date *

Enter as MM/DD/YYYY

Second Choice Time *

Third Choice Date *

Enter as MM/DD/YYYY

Third Choice Time *

Transportation means *

For virtual field trips, indicate Zoom

Educational Goal *

What curriculum standard are you trying to meet or what is the major take away that you want for your group?

Notes

Indicate other relevant information not addressed elsewhere in the form such as accessibility needs.

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