Prairie Connections Participation Request

Fill out a separate form for each day your school will be participating.
Submit this form as soon as possible.

Primary Contact Person:
School Name:
Address:
City:
State:
Zipcode:
County:
School Phone:
AEA Region Number
School Fax:
Teacher Home Phone:
Email Address:
  Would you like to be added to the K-12 Demo Project Electronic Mailing List?
Yes No
ICN Site Name: Node Number:

 

Session Request:
These are One Hour Sessions. Rank Your Preferences (1st, 2nd, 3rd).

Please submit a separate form for each day your school will participate or grade grouping that will participate.

Monday, September 21, 1998.   Grades 5-6
Grade 5 Grade 6       Total Number of Students:
9:00 a.m. 11:00 a.m. 1:15 p.m.
Tuesday, September 22, 1998.   Grades 7-8
Grade 7 Grade 8     Total Number of Students:
9:00 a.m. 11:00 a.m. 1:15 p.m.
Wednesday, September 23, 1998.   Grades 9-12
Grade 9 Grade 10 Grade 11 Grade 12   Total Number of Students
9:00 a.m. 11:00 a.m. 1:15 p.m.

Submit a Question

Participants will have the opportunity to submit questions in advance of the session. The producers will review all submissions and will select those that are most suited to the program's objectives. If you have questions that you would like considered for the program, please enter them into the box below.

If a question is selected, the participating teacher will be notified. The teacher is required to attend an inservice over the ICN scheduled for September 15, 4:00-5:00 p.m.

This form must be received at IPTV by 8:00 a.m. on Tuesday, September 8, 1998, in order for your question to be considered.



Partnerships

Prairie Connections will link schools that would like to do collaborative projects with each other. If you have an existing partnership with another school that you would like to utilize during Prairie Connections, indicate that below. If you would like to set up a partnership, check the box. If you have a school that you would like to partner with, enter its name.

This form must be received at IPTV by 8:00 a.m. on Tuesday, September 8, 1998, in order for your partnership request to be arranged..

We want to work with our existing partner, which is:

We do not have a partner, but would like one:
If you can, please partner us with the following school:


Additional Information
Let us know if you have students with disabilities who have special requirements. Tell us what those requirements are and we will try to accommodate their needs.

We DO NOT want to be a "view only" site.

We will attend the teacher inservice on September 15, 1998, 4:00-5:00 p.m. Yes No
We will attend at the following ICN site:


For more information on how to participate, contact: For more information on submitting questions and partnerships, contact:
Pam Hill
Iowa Public Television
800-532-1290
515-242-5417
515-242-5415 (Fax)
phill@iptv.org
Jenny Townsend
Iowa Public Television
515-725-9723
515-242-5415 (Fax)
jenny@iptv.org
   

          
Note: Fill out a separate form for each day your school will be participating.


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