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Site Name

First name

Last name

Email

Phone

Address

What type of Site are you?

Program Type

What type(s) of program are you interested in? Choose all that apply.

Program Format

In-person, on-site

Remote: Synchronous (live) video

Remote: Asynchronous (prerecorded) video

Other

What format(s) would you like to use for your program? Choose all that apply.

Proposed Date and time (1st choice)

Month

Day

Year

Time

HoursMinutes

Enter up to 3 sets of proposed dates and times for your programs.

Proposed Date and time (2nd choice)

Month

Day

Year

Time

HoursMinutes

Enter up to 3 sets of proposed dates and times for your programs.

Proposed Date and time (3rd choice)

Month

Day

Year

Time

HoursMinutes

Enter up to 3 sets of proposed dates and times for your programs.

Anticipated Number of Classrooms/Groups/Participants

Number of times you'd like the Afoutayi artists to see each classroom/Group

Accessibility Needs

Please outline any accessibility needs we can meet for your participants (e.g Language, mobility, other).

Additional Information

Please tell us a bit about the program you are looking for, share some about your goals, ideal format, and anything else you'd like us to know.

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