Ambassador Outreach Request Form (2012-13)

Submit this form at least 3 weeks prior to your earliest requested museum-in-a-box presentation date.

The Ambassador Outreach Program is a three-part program, which includes a museum tour and two classroom visits. The program cost is $200 per class; teachers and chaperones are free and required. Payment is due upon arrival. Make checks payable to: Honolulu Museum of Art School.

There is a maximum of 60 students per museum tour. You must submit separate forms for additional tours. Due to the popularity of our outreach and school programs, we may not be able to accommodate all requests. Do not make transportation arrangements until you have received email confirmation of your assigned date.

CONTACT INFORMATION
Teacher Name * First Last
Email *
Confirm Email *
School Phone *
Alternate Phone
SCHOOL INFORMATION
School Name *
School Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Is your school * Public Private Charter Home School Other
School District
Is your school Title One? * Yes No
GROUP INFORMATION
Grade Level *
Number of Students (maximum of 60 per request form) *
Number of Classes *
Number of Chaperones (required, 1 per 10 students in grades 1-12 or 1 per 5 students in grades PreK and K) *
PROGRAM SELECTION
Theme Selection - for descriptions visit www.honoluluacademy.org/schooltours *
CLASSROOM VISIT: DATE & TIME
PRE-VISIT "Museum-in-a-Box" Presentation

The pre-visit: Museum in-a-box, presented by an Ambassador, is the first part of the three-part program. Please select dates that precede the museum tour.
Special Requirements/Requests? - If your group has any special requests or needs please indicate them here.
Pre-visit: Museum-in-a-box presented by an Ambassador (Presentation is one hour)

Date 1st Choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm
Date 2nd choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm
Date 3rd choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm 1:30 pm
MUSEUM TOUR - DATE & TIME
You must choose dates and times from the Availability Calendar below.
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MUSEUM TOUR CHOICES

Date 1st choice (You must choose from the availability calendar above)
* / MM / DD YYYY
Start Time 1st choice * 9:00 am 10:30 am
Date 2nd choice (You must choose from the availability calendar above) * / MM / DD YYYY
Start Time 2nd choice * 9:00 am 10:30 am
Date 3rd choice (You must choose from the availability calendar above) * / MM / DD YYYY
Start Time 3rd choice * 9:00 am 10:30 am
CLASSROOM VISIT: DATE & TIME
POST-VISIT: Art Project Presentation

The post-visit: Art project, presented by an Ambassador, follows the museum tour and is the culminating visit back in the classroom. Please select dates that come after the museum date.
Post-visit: Art Project presented by an Ambassador (Presentation is one hour)

Date 1st Choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm
Date 2nd choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm
Date 3rd choice * / MM / DD YYYY
Start Time (Please select one time for every classroom) * 8:30 am 9:00 am 9:30 am 10:00 am 10:30 am 11:00 am 11:30 am 12:00 pm 12:30 pm 1:00 pm
PROGRAM FEE

The Ambassador Outreach Program cost $200 per classroom; public schools that have a Title 1 status may seek program subsidy. Payment is due upon arrival to the museum. Make checks payable to: Honolulu Museum of Art School.
Number of classrooms X $200.00 = $ . Dollars Cents
If your school is Title One, are you requesting program and/or bus subsidy? Please do not request this subsidy if you are not a Title One school. Yes, we are requesting program subsidy Yes, we are requesting bus subsidy Yes, we are requesting both bus and program subsidy No, we are not requesting any subsidy
Mahalo nui!
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Ambassador Outreach Request Form (2012-13)

Ambassador Outreach Request Form (2012-13)

CONTACT INFORMATION

SCHOOL INFORMATION

GROUP INFORMATION

PROGRAM SELECTION

CLASSROOM VISIT: DATE & TIME PRE-VISIT "Museum-in-a-Box" Presentation

MUSEUM TOUR - DATE & TIME You must choose dates and times from the Availability Calendar below.

<a href="https://www.quickbase.com/db/bf96ppd7s?a=dbpage&pageID=9" title="test">test</a>

CLASSROOM VISIT: DATE & TIME POST-VISIT: Art Project Presentation

PROGRAM FEE

Mahalo nui!

For security reasons, please complete the Captcha challenge below. If you have trouble reading the words, press the refresh button to see a new challenge or the audio button to hear a new challenge.

CLASSROOM VISIT: DATE & TIME
PRE-VISIT "Museum-in-a-Box" Presentation

MUSEUM TOUR - DATE & TIME
You must choose dates and times from the Availability Calendar below.

CLASSROOM VISIT: DATE & TIME
POST-VISIT: Art Project Presentation