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CMOV at TC
Evening of Play

In-Person Outreach Interest Form

I AM SCHEDULING:
- IN-PERSON OUTREACH (visit)
- VIRTUAL OUTREACH (Zoom)
THIS FORM IS FOR IN-PERSON OUTREACH VISITS ONLY. IF YOU ARE TRYING TO SCHEDULE A VIRTUAL OUTREACH, PLEASE RETURN TO THE OUTREACH PROGRAMS PAGE AND SELECT THE VIRTUAL FORM.
Name of organizer*
First Last
Email*
Phone*
Institution*
Are you a Title I institution
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Grade level*
Select all that apply. Use the Control key to select more than one.
- Pre-K
- Kindergarten
- 1st
- 2nd
- 3rd
- 4th
- 5th
- 6th
Number of children*
Program desired*
Please select the program(s) you want us to present to your class during our virtual outreach. Use the Control key to select more than one. Grade designations reflect state standards met.
What language would you prefer for your program?
- English
- Spanish
- Bilingual
Date - First choice*
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time*
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Date - Second choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Date - Third choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?

: Hours

Minutes

AM/PM
Name
This field is for validation purposes and should be left unchanged.