Outreach Request Form – School Visit

Please note that if you have scheduled a group tour with the Museum, you should not submit a speaker request form. Whenever possible, a speaker will be included as part of your scheduled field trip.

The Illinois Holocaust Museum requires a minimum of 60 students to schedule an outreach visit. Schools must be located a minimum of 60 miles from the Museum. Schools located less than 60 miles from the Museum should schedule a school field trip.

  Classroom Speaker Outreach Visit Grades 6 and up
School Name*:
Contact Person*:
Work Phone:

Home or Cell Phone:
Address of Presentation:
City:
State:
Zip:
Fax:
Email*:
Grade Level of School:

Subject Taught:
Grade Level of Class (6+):
Number of Children:
Number of Adults:
School Type:

Other:

If you would like to request a specific speaker, please write his/her name here:
Date and Time of Visit
First Choice:
  ,     Time:
Second Choice:
  ,     Time:
Third Choice:
  ,     Time:
Students Degree of Preparation

How many days and/or weeks have your students studied the Holocaust prior to their visit?
What have your students read or are currently reading about the Holocaust?
What films or movies have your students viewed about the Holocaust?

Please type the letters into the form:
captcha

 

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