| SCHOOL INFORMATION
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| 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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| Check one |
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| School District |
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| Local district # (LAUSD only) |
If not applicable, type "none" |
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| 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 |
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| Email Addresses of ALL teachers attending the tour. |
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| Names of all teachers attending the 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?
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| CLASS INFORMATION |
| Grade Level |
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| Estimated # of students (15-40) |
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Estimate 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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| Additional Comments |
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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 2013-June 2014.
Blackout dates will not appear as options in the choice below. |
| American Identity: Immigration in the Age of Diversity gallery programs begin at 10:00 a.m., except where noted and last 2.0 hours. |
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| First Choice |
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| Second Choice |
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| Third Choice |
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| Stories of Struggle and Resilience: The Journey of Modern European Jews gallery programs begin at 11:15 a.m., except where noted and last 2.0 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) |
| 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 and ask to speak with Ruth Ann.
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| Admission Scholarship |
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In order to be considered for an admission scholarship, please answer the following questions:
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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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Input Required |
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3. How does the Skirball's mission dovetail with your teaching practices? (limited to 150 words)
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Input Required |
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If your form has been submitted successfully, you will receive an automated email immediately. If not, email education@skirball.org.
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