Tickets Application

* required information
 
First Name:*
Last Name:*
Position/Title:*
School / Organization:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Business Phone:*
Email:*
Fax:
Cell Phone:*

Total Number of students, grades 7 -12, including Adult Chaperones who plan to attend the MOT experience.:
*
Grade Level(s) of Participants:*
NOTE: Priority is given to schools that can visit the MOT by the end of December 2014.:
Preferred Date 1:*
(mm/dd/yyyy)
Preferred Date 2:*
(mm/dd/yyyy)
Preferred Date 3:*
(mm/dd/yyyy)
Requested Arrival Time:*
BRIEFLY ANSWER THE FOLLOWING: (200 words maximum for all three questions):
What percentage of your students are Title I?:*


What are your objectives in bringing students to the MOT (e.g. curriculum links? campus climate?):
*
What follow-up initiatives are planned?:*
How did you hear about this grant funded opportunity?:*
Have you ever brought a class to the MOT before?:*
Yes
No
If this is not your first visit, how was the previous trip funded?:*
Would you be able to bring students to the MOT without funding from this grant?:*
Yes
No
How do you plan to provide follow up and support to your students after the Museum of Tolerance experience?:*
Are there any obstacles to bringing students, aside from funding?(eg. calendar, transportation costs, substitute teachers, etc.):*
Yes
No
If yes, how can you address them? What support do you need?:*

Thank you for your application!

For more information, contact Group Reservations at (310) 772-7639.

        

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