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Skirball Cultural Center

2701 N. Sepulveda Blvd, Los Angeles, CA 90049 - (310) 440-4500
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School Tour Request Grade 5


School Tour Request Form - Grade 5

SCHOOL INFORMATION
School Name
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Address
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City
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State
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ZIP
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Current Principal
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Phone
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Fax
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School District
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Local district # (LAUSD only)
If not applicable, type "none"
Are you a Title 1 school?
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TEACHER CONTACT INFORMATION
Teacher Name
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Position
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Contact Phone
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Alternate Phone - Please provide phone number to be used on the day of the visit.
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Main Contact Email
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Email addresses for all other teachers attending with you.
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Names of all teachers attending this field trip
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Is this the first time you are bringing students to the Skirball on a field trip?

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If NO, how many years have you been bringing your classes on field trips?

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If YES, who referred you to the Skirball?

CLASS INFORMATION
Grade Level
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Estimated # of students (min.15; max. 60)
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Estimated number of chaperones
(teachers and parents, max. 10)

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SPECIAL NEEDS*
*Information on your students' special needs (learning disabilities, physical limitations, gifted, ELL, etc.) helps us customize and plan your visit.

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SCHEDULING INFORMATION
  • Please select three dates when you would like to schedule your gallery program.
    We will make every effort to accommodate you.
  • All dates are filled in the order received.
  • Gallery programs are available Tuesday-Friday, September 2014-June 2015.
  • Americans and Their Family Stories gallery programs begin at 10:00 a.m., except where noted and last 2 hours.

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    First Choice
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    Second Choice
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    Third Choice
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    TRANSPORTATION AND ADMISSION SCHOLARSHIPS (Public schools only)
    Scholarship Applications (YOU MUST check each box to indicate your understanding of the terms of these agreements)
    Admission Scholarship


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    Bus Scholarship Terms








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    If you need assistance finding a bus company, the Skirball has an account with American Transportation Systems. For more information please visit its website at www.amtrans.us or call (562) 531-8000.
    In order to be considered for an admission and/or a bus scholarship, please answer the following questions:
    1. What financial restraints prevent you from paying the admission fee? (limited to 150 words)

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    2. How will a visit to the Skirball supplement your classroom curriculum? (limited to 150 words)

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    3. How does the Skirball's mission dovetail with your teaching practices? (limited to 150 words)

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