TEACHER REQUEST FORM

 
 
 Speaker/Special Events Teacher Request Form 

 
 

Community Resource Bank (CRB) Teacher Request Form – Thank you for submitting a request for a classroom speaker or curriculum enrichment event (Career Fair, Science/health/Community Night…) Thanks, Joanie Sousa

·         Your completed form is received in the CRB’s mail box and will be processed as quickly as possible. Please include your full name and contact information and use the Special Notes text box for specific details about this request.

·         You can also use this form if you have already scheduled your own speaker. Please list the speaker name and email in the Special Notes text box and I will register & confirm your scheduled speaker.

 


   
 
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For this request. First & Last Name. Including hyphenations.
 
   
 
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Office, Cell, both. Your choice
 
   
 
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You are requesting or Topic of presentation/speaker you would like me to find. What are your goals for this unit of study and what do you hope your students learn from this presentation...What should be emphasized
 
   
 
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(1st Choice)
  Select Date
mm/dd/yyyy
   
 
  Select Date
mm/dd/yyyy
   
 
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needed for this speaker?
 
   
 
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Please list the START TIMES for the # of presentations you need. If you need more class period time slots please list additional start times in the SPECIAL NOTES section below.
 
       
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Roughly how many students will be attending each presentation scheduled for the day.
 
   
 
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List all grades you are scheduling for. Example 1st or 1-3rd or 2nd, 4th, 9th....
 
   
 
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of Presentation(s)
 
   
 
Please include any information that might be helpful for this request.Example:Include additional alternate dates or alternate times, special needs of students, NO Schedule dates...
 
   
 

Community Resource Bank (CRB) Teacher Request Form – Thank you for submitting your request for a classroom speaker. You, your presenter and your school’s administrative assistant will receive an email confirmation upon completion of this request. Please contact me for any reason and notify me immediately with changes to this scheduled event. Joan.Sousa@d11.org 719-520-2302.

 

 


   
 
 
 
 Done