COMMUNITY CLASSROOM DVD REQUEST FORM

Please complete all requested fields below. This information will help us better understand the community of educators we serve.

Allow 4-6 weeks for ITVS to process your order and send the requested materials. Note that at the present time, we can only fulfill requests inside the U.S. (including Puerto Rico, American Samoa, Guam, Virgin Islands).

Streaming video and classroom activities are available at PBS.org. Thank you for your interest in Community Classroom.

CONTACT INFORMATION

School/Organization

*First Name

*Last Name

Title

*Address Line 1

Address Line 2

*City

*State

*Zip

Phone

Fax

*Email

Website

*Organization Type

Nonprofit
NGO
School
Other

COMMUNITY CLASSROOM MATERIALS

In an effort to reduce shipping costs, we ask that you request no more than three titles per order.

*Requested Titles

Please indicate your educational setting, providing the class subject or course title you instruct, youth program, training field or other descriptive information.

*Educational Setting

College/University
High school
Middle school
Youth Organization
Professional Training
Other

Please provide a brief description of how you will use the COMMUNITY CLASSROOM materials:

*Please estimate how many students will be reached using these resource materials in the current school year:

*How did you find out about us?

CONTACT INFORMATION

COMMUNITY CLASSROOM MATERIALS