| Please note that all school tour dates for the 2011-2012 school year have been booked, we are no longer accepting school tour requests. Information regarding 2012-2013 school tour registration will be available soon. Please check back in May, 2012 to learn more about our offerings for the 2012-2013 school year. |
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| SCHOOL INFORMATION
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| School Name |
Input Required |
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| Address |
Input Required |
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| City |
Input Required |
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| State |
Input Required |
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| ZIP |
Input Required |
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| Current Principal |
Input Required |
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| Phone |
Input Required |
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| Fax |
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| Check one |
Input Required |
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| School District |
Input Required |
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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 |
Input Required |
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| Contact Phone |
Input Required |
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| Alternate Phone |
Input Required |
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| Email Address |
Input Required |
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| Names of all teachers coming on trip |
Input Required |
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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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How did you learn about the school outreach program that you are registering for today?
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| Please Specify |
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Do you currently receive a printed brochure of Skirball school programs?
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How would you prefer to learn about our programs?
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| CLASS INFORMATION |
| Grade Level |
Input Required |
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| Estimated # of students |
Input Required |
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Estimate number of chaperones
(teachers and parents, max. 10) |
Input Required |
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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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Input Required |
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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 1, 2010-June 30, 2011.
Blackout dates will not appear as options in the choice below. |
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All gallery programs begin at 10:00 a.m., except where noted and last 1.5 to 2 hours. Select only one.
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| First Choice |
Input Required |
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| Second Choice |
Input Required |
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| Third Choice |
Input Required |
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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 |
Input Required |
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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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Input Required |
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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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