Session Scheduler

Your Name*
Email*
Phone*
School Name*
School Street Address*
School Zip*
What grade level will we be teaching?*
- Early elementary (K-2)
- Elementary (3-5)
- Middle (6-8)
- High (9-12)
Please note that you may sign up for only one of these grade levels at a time. We have created different lessons for different grade levels to ensure that all of our material is age appropriate. If you would like to sign up on behalf on two separate grade levels, please submit this form twice.
If you are signing up on behalf of more than one classroom to be taught together, how many classrooms does this sign-up represent?*
- N/A - one classroom
- 2-3 classrooms
- 4-6 classrooms
- 6+ classrooms
- Assembly format (entire school, entire grade, etc.)
What subject(s) are taught in this/these classrooms?*
(Write N/A if you are signing up for an assembly).
Total number of students*
Please list your earliest date preference to be no less than 10 days from the date you submit this form.
Date preference 1: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 1 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 2: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 2 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 3: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 3 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 4: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 4 - Group start time (EST)*
All sessions will run 45 minutes.
Would you like to book another session?
- Yes
Session 2: Please list your earliest date preference to be no less than 10 days from the date you submit this form.
Date preference 1: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 1 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 2: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 2 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 3: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 3 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 4: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 4 - Group start time (EST)*
All sessions will run 45 minutes.
Would you like to book another session?
- Yes
Session 3: Please list your earliest date preference to be no less than 10 days from the date you submit this form.
Date preference 1: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 1 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 2: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 2 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 3: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 3 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 4: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 4 - Group start time (EST)*
All sessions will run 45 minutes.
Would you like to book another session?
- Yes
Session 4: Please list your earliest date preference to be no less than 10 days from the date you submit this form.
Date preference 1: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 1 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 2: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 2 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 3: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 3 - Group start time (EST)*
All sessions will run 45 minutes.
Date preference 4: (Oct 5 - Apr 29)*
Date Format: MM slash DD slash YYYY
Date Preference 4 - Group start time (EST)*
All sessions will run 45 minutes.
Which of the following responses most accurately describes how you will be delivering this virtual course to your classroom?*
- Teacher logs on and projects screen to front of classroom. Students watch projection.
- All students log onto the Zoom on their own laptops.
- Students share laptops to log onto Zoom in groups.
- Students log on from a school computer lab.
- I’m not sure.
- Other
Other (Please Describe)
Demographic Questions

We collect demographic information as part of our evaluation efforts for the HEAT program. Any data shared with our evaluation partners will be shared without names. All fields are required to submit, so if you do not know the answers to any of the demographic questions, write “N/A.” If you do not have any students who match a description, write “0” instead of leaving the field blank.
How many students in each of the following grades will be in the HEAT group you’re signing up for?
Kindergarten*
First Grade*
Second Grade*
Third Grade*
Fourth Grade*
Fifth Grade*
Sixth Grade*
Seventh Grade*
Eighth Grade*
Ninth Grade*
Tenth Grade*
Eleventh Grade*
Twelfth Grade*
List the percent of students who identify as each of these races at your school by relevant grade level. Data from 2020-2021 school year, please.

Example: You are signing up a class or group with 10th and 11th graders. Your school’s 10th grade is 50% African American, and your school’s 11th grade is 55% African American. Write something like “10th grade, 50%/ 11th grade, 55%” under the African American option.
African American or Black*
Hispanic or Latino*
White*
American Indian*
Pacific Islander*
Other*
List the percent of students who identify as each of these genders at your school by relevant grade level. Data from 2020-2021 school year, please.

Example: You are signing up a class or group with 10th and 11th graders. Your school’s 10th grade is 40% male, and your school’s 11th grade is 50% male. Write something like “10th grade, 40%/ 11th grade, 50%” under the male option.
Female*
Male*
Non-Binary*
Other*
Just so our instructors have context for your students’ COVID experience, please briefly describe any masking, vaccination, or social distancing guidelines in place in your school and area. If you have anything you’d like to add about your students’ or area’s perspective on COVID and vaccinations, please feel free to do so here.*
Comments
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Session Scheduler

Demographic Questions