Classroom Program Request

Email Address *

Coordinating Teacher First Name *

Coordinating Teacher Last Name *

Daytime Phone Number *

Full School Name *

Postal Code *

Preferred Month *

Course Subject To ensure accurate curriculum connections, what subject/course does this pertain to?

Address Line 1 *

Address Line 2

City/Town *

Province *

Will this be an in-person or online/virtual program? *

Online In-person

Please select the program you’re interested in *

Special Request If you are interested in a topic not in the list above, please let us know what you are thinking!

Grade If different than the program grade (e.g. asking for a Grade 5 program for a class of Grade 4 students)

Number of Participating Classes *

Approximate Number of Students *

If your class is a mixture of grades, please specify here

Any specific dates in mind?

Any specific times in mind?

Any additional information or comments?

How did you hear about Inside Education Programs? Select as many as apply.

Inside Education’s Website Social Media I am a past participant Inside Education’s Newsletter Teachers’ Conference Colleague Directly from Inside Education Staff Other

Have you used any of our other products and services? Select as many as apply.

Learning Resources Field Programs Teacher Professional Development Programs Grants Youth Summits I did not know you had other products and services I know you have other products and services, but I choose not to use them

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First Name *

Last Name *

2024-2025 Classroom Program Requests

School Address

Additional Information

School Address

Additional Information

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