Section A: General Information

School Organization

Address

City

Postal Code

Contact Person

Contact Title

Email

Phone

Fax

Organization Description

Past Experience

Section B: Workshop Options

Discipline

Duration

Duration Other

Section C: Workshop Schedule

Preferred Workshop Dates

Timeslot

School Day Starts

Morning Recess Begins

Morning Recess Ends

Lunch Begins

Lunch Ends

Afternoon Recess Begins

Afternoon Recess Ends

School Day Ends

Section D: Workshop Choices

Workshop Choice #1

Workshop Choice #2

Workshop Choice #3

Section E: Participation

Number of Classes

Grade Levels

Total Children

Section F: Curriculum Request

Curriculum Links
 yes no

Section G: PD Workshops

Professional Development Workshops
 yes no

Professional Development Discipline

Section H: Other

Other Comments