Bill of Rights Institute Programming Request Questionnaire
District, School, or Association Name:
Primary Contact | First Name
Primary Contact | Last Name
Primary Contact Email Address:
Primary Contact Phone Number
Have you already discussed this request with a Bill of Rights Institute staff member? If so please list his/her name.
About the Program
Type of Programming Requested
One Day Seminar
Multi Day Seminar
Other (please list)
Other Type of Programming Requested
What is the location for the training?
At my school/district building - teachers will be in a common space
Online - teachers will not be in one common place
I don't know yet and I may need help finding a space
Other - please list
How many teachers do you anticipate being in attendance?
Please describe the teacher population that will be in attendance (eg. grade levels taught, subjects, etc.)
Is there a particular theme or curriculum you would like the program to address?
What are your top three goals or aims for this professional development programming?
Is there anything else you would like us to know about your request?”
Please briefly discuss the kind of professional development experiences your group has is use to or has had in recent years.
Preferred Program Date(s) or Date Range:
Program Start and End Time
Is there a lunch or break built in?
If lunch is provided is it on-site?
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