Virtual Workshop Reservation Form

About Your Group

All communications will be directed to the contact information provided here.

SCHOOL NAME*

SCHOOL LOCATION*

SCHOOL TYPE*

SCHOOL ADDRESS*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SCHOOL PHONE*

SCHOOL FAX

YOUR NAME*

First Last

YOUR PHONE*

For international phone numbers, please type 000-000-0000 in this required field, and use the comments section at the bottom of this form to provide your actual number. We highly recommend providing a US number that you can be reached at during your visit.

YOUR EMAIL*

NUMBER OF STUDENTS*

Maximum of 35 per workshop session. We can accommodate multiple sessions. Please inquire in comments field at the end of this form.

STUDENT GRADE LEVEL*

Check all that apply.

ACCESSIBILITY

Does your group have any accessibility needs?

SPECIAL EDUCATION
ELL
PHYSICAL DISABILITIES
OTHER

Please describe below:

Date and Time of Workshop

Virtual workshops are on Mondays, but we may be able to accommodate another day if needed. We recommend you book your virtual workshop at least three weeks in advance. NOTE: May 2021 virtual workshops are SOLD OUT.

FIRST CHOICE MONDAY DATE*

SECOND CHOICE MONDAY DATE*

THIRD CHOICE MONDAY DATE*

START TIME*

:

Platform

We can accommodate a variety of virtual meeting platforms.

What meeting platform would you prefer?*

Zoom (school as meeting originator)
Google Meet (school as meeting originator)
Microsoft Teams (school as meeting originator)
Zoom (CHM as meeting originator)
Other/not sure (please include information in the comments field at the end of this form)

Workshop Option

Please select the workshop you are participating in. Your confirmation letter will indicate any associated fees. Full payment is due by the day of program.*

STUDENT WORKSHOP – PAINTED MEMORIES: THE GREAT CHICAGO FIRE

Recommended for grades 3-5. Maximum 35 students per session. $50 per workshop session.

YES

STUDENT WORKSHOP – FACING FREEDOM

Recommended for grades 6-12. Maximum 35 students per session. $50 per workshop session. Choose ONE topic.

Additional Questions

WHAT DO YOU TEACH?

WHY ARE YOU MAKING A VIRTUAL WORKSHOP RESERVATION?

Please describe below:

WHERE DOES THIS WORKSHOP FALL WITHIN YOUR INSTRUCTIONAL PLAN?

COMMENTS

Please provide any additional details or questions regarding your requested workshop.

Submit Below!

Click the “submit” button below and wait for a confirmation message to appear (a copy will also be emailed to you). Please do not close or refresh this page.

Virtual Student Workshop Reservations