Virtual Classroom Program Request Form

2. Fill out this form to request a virtual Classroom Program through the CCWD Water Education Program.
   Please note: Classroom Programs are available for 3rd, 4th, and 5th grade classes.

   Please note: Classroom Programs are available for 3rd, 4th, and 5th grade classes.

4. Teacher Name*

6. School*

8. Email Address*

10. Second Email Address

12. Phone Number*

14. School District*
    -- Select One --MDUSDAUSDPUSDMUSDOUESDBUSDPrivate SchoolHome School

16. Grade Level*
    -- Select One --3rd Grade4th Grade5th Grade

18. Number of programs*

    *In the virtual environment, we have found it beneficial for learning to cap virtual classroom programs to no more than 40 students, so if you have four grade-level classes, we would recommend four classroom programs.

20. Number of students per program*

22. What virtual platform do you use in the classroom?*

    (i.e. Zoom, Google Classroom, SeeSaw, Microsoft Teams, etc.)

24. Preferred days of the week

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
25. Preferred months of the school year

    1. September
    2. October
    3. November
    4. December
    5. January

    1. February
    2. March
    3. April
    4. May

27. What time of day works best for your students?*

29. Special Accommodations

31. Comments/Questions

33. Key Points
    <ul><li>You will be contacted by CCWD to schedule programs.</li><li>Questions about scheduling or programs? <a class="Hyperlink" title="Email Christine Helton" href="mailto:chelton@ccwater.com">Email Christine Helton</a> with CCWD.</li><li>Program duration is 60 minutes.</li><li>Program format: We ask that you make our instructors a temporary host on your account so they can conduct the program, share their screens, etc.</li><li>Please select the option to email yourself a copy for your records below and submit the form.</li></ul>

    • You will be contacted by CCWD to schedule programs.
    • Questions about scheduling or programs? Email Christine Helton with CCWD.
    • Program duration is 60 minutes.
    • Program format: We ask that you make our instructors a temporary host on your account so they can conduct the program, share their screens, etc.
    • Please select the option to email yourself a copy for your records below and submit the form.

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field