Today’s Date______________________________
Center for Puppetry Arts IVC Program Request Form
Program Title (s):
Desired Date(s):
1st choice
2nd choice
3rd choice
Desired Start Time(s) (List it in Eastern Standard Time):
1st choice
2nd choice
3rd choice
Scheduling Contact Name:
Agency/School Associated with:
Address
Street City State Zip
Phone
Fax
Organization/ School Information
Agency Name (if different from above):
School name (if different from above):
Address
Street City State Zip
Phone
Fax
Title 1 funding? (Tracking for our grants and funding agencies) YES NO
Teacher name
Phone
Grade level
Number of students*
*For optimum interaction class size is suggested at no more than 30 students per classroom.
Tech Contact:
Name
Phone
Cell Phone:
Phone Number During the Event
Connecting via ISDN or IP?
Equipment make/model (ex: Tandberg 880MXP)
Billing Contact:
Name/Agency Name:
Address
Street City State Zip
Phone
Once we receive all the info back from you, we will schedule the conferences & we will get in touch with your tech person to set up a test call prior to the conference.
We also will send a teacher letter with instructions of how to download everything you need from our website - it is crucial that ALL the materials for the puppet be prepared IN ADVANCE OF THE PROGRAMS.
We do offer multi-point connection options. Please call for more information. 404-881-5117.
Thanks!
The Distance Learning Team
Sara Burmenko, Distance Learning Director
Jeffrey Zwartjes, Distance Learning Artist-in-Residence
Direct studio line: 404-881-5117
http://www.puppet.org/programs/distance-learning/
1404 Spring Street, NW at 18th
Atlanta, GA 30309-2820 USA