ITVS: Community Classroom DVD Request Form

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*ST*ZIP

PhoneFax

EmailWebsite

*Organization Type:
Nonprofit
NGO
School
Other

If a school, please specify type:
Charter
Public
Independent (not taxpayer funded)
Home-based
Other

If a school, please specify subject area:
Health and Fitness
Math
Media Literacy
Performing Arts
Reading and Language Arts
Science and Tech
Social Studies
Visual Arts
Other

COMMUNITY CLASSROOM MATERIALS

*Requested Titles:
COPYRIGHT CRIMINALS
HIP-HOP: Beyond Beats & Rhymes
KNOCKING
SENTENCED HOME
VOTE DEMOCRACY
WOMENS EMPOWERMENT

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:
Less than 50
50-100
100-150
150-200
Other

Once all of the information above is complete and correct, you must:

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