DC Arts and Humanities Education Collaborative


Request for Black Boy with Literature to Life
Name (first and last) *
Email *
Phone *
School Name (please write the official name). *
Ward *
Please select the grade levels of students that will be attending: *	Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12
Number of students attending: *
Number of adult chaperones attending: *
How many separate classes make up the total number of students above? *
Please provide the name and email of your school's Business Manager (MSL/DSL). *
Please provide the name and email of your school's Principal. *
If you are filling out this form on behalf of another teacher, please list their contact information here (Name, email, and phone number): *
Is your school considered Title I? *	Yes No
Please share any accessibility measures needed for your students (we will do our best to accommodate these, but they are not guaranteed): *
If available, will you need printed materials in:	Spanish Amharic
Have you ever signed up for an arts and humanities field trip before now? *	Yes No
Did you turn in the appropriate field trip application upon requesting this program? *
I will ensure that my students and I will complete the assessment surveys provided by the DC Collaborative within 1 week of completing the learning experience. *
I have read, understand and will abide by the School Partner Community Standard form. *	Yes No
Which date(s) are you requesting for "Black Boy" with Literature to Life? *	05/11/2026 05/12/2026 05/13/2026 05/14/2026 05/15/2026

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