PIAL Visit Request

Would you like to request the PIAL curriculum or ADMYRE program?

PIAL in-person

PIAL online

ADMYRE in-person

ADMYRE online

Staff Contact Name

Staff Contact Email

What is the name of the class you are requesting a visit for?

How many students are in the class period(s)?

What are the grades in attendance for this course?

What are the start/end times and days of each class period(s)?

Example: 10:30-11:15 M, W, F

Choose the topic(s) you would like us to present.

We are updating our curriculum and will add more topics as they are completed. (If you are requesting multiple presentations, see the note at the end for Requesting Multiple Visits.)

Spanish Materials Requested

Yes

How many Spanish speaking students?

How does this topic relate to what students are learning in class right now?

Are there any students with special needs/IEPs and/or aides or paras who will be in the classroom?

This information helps our facilitators be more aware and sensitive to these needs. If yes, please explain below. If no, please indicate NA.

Are there class dynamics and/or life experiences in any of the class periods that PIAL staff should be aware of?

This can include any recent student experiences of sensitive topics that may invoke an emotional response. If yes, please explain below. If no, please indicate NA.

Please indicate if you are on a semester, trimester or quarter system, and the ending dates for each.

Example: Trimester ending on Nov. 17, Feb. 24 and May 25.

Please share any planned days off your school has within two weeks of your intended visit date.

Sharing this information will help our team to schedule surveys send dates with you based on your school schedule.

Example: October 2; November 14-21

Will a projector be available for the PIAL staff to use?

Yes

Will internet be available?

Yes

How did you hear about PIAL?

Is this your first visit from PIAL?

Yes

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