HMLA Virtual Student Tour Reservation

School
Do any of the following aplpying to your students?

Do any of the following aplpying to your students? Title I Schoolwide Program At least 50% of my students receive free or reduced lunch None of the Above
Teacher/Contact
Lead Teacher for Day of Virtual Tour Lead Teacher for Day of Virtual Tour First Last
School Address School Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
School District
School Zone
Teacher's Email
Cell (for day-of contact)
Number of Students
Age Level

Age Level 4th Grade 5th Grade 6th Grade 7th-8th Grade High School College If Other
Has your school ever visited Holocaust Museum LA in the past? If so, when?
Date Requested Date Requested / MM / DD YYYY
Alternative Date Alternative Date / MM / DD YYYY
Start Time Requested Start Time Requested : HH MM AM/PM
Alternative Start Time Alternative Start Time : HH MM AM/PM
Are you interested in having a Holocaust survivor speak to your students?

Are you interested in having a Holocaust survivor speak to your students? Yes No
If you would like a Holocaust survivor to speak to your students, what day is best?

If you would like a Holocaust survivor to speak to your students, what day is best? Same day as tour Different day as tour
Tell us about your class
Rate your students' knowledge of the Holocaust

Rate your students' knowledge of the Holocaust Excellent Good Satisfactory Limited
Describe your class's familiarity with the Holocaust
Please list any Holocaust-related media your class has studied (books, movies, music, etc.)
How did your hear about Holocaust Museum LA?
How is your school conducting classes this year? Please check the following that apply to your class:

How is your school conducting classes this year? Please check the following that apply to your class: Virtual classes only In-person classes only A mix of both virtual and in-person classes