Individual Teacher Service Request Form

This form is for requesting an individual service. If you are requesting a service on behalf of ALL teachers in your grade level use the Grade Level Service Form.


Teacher Information

NOTE: Required fields are indicated with an *



Home Phone*:
Preferred phone:
Grade*:
Class Size
(# of Students)*:
40 Max
 
If your class size is over 32 students, please explain in the comments area below.
 
Classroom #:
Would you like to request a scholarship? Yes
 
Please read the scholarship information (opens in new window) to see if your school qualifies.

School Information

Processing your request will go easier if all the teachers at your school use the same full school name. Abbreviated and shortened school names can slow processing. Thank you!

School District:

Type of Service Requested

For more information about each service type , please see our Service Brochure (opens in new window).

Service Type*:
Alternative Service Type:
Month Requested*:
Alternate Month(s):
For multiple months,
Ctrl+Click (Windows) or Command(Apple)+Click (Mac)
   
Do you wish to have a combined service with another teacher in your grade level?
Combined Service: Yes
If "yes" then name them here:
   

Requests are accepted on a first-come, first-served basis, and will not be processed if this form is not complete.

If we cannot fulfill your request you will be placed on our waiting list.

We do not accept applications by mail, phone or fax!

By clicking the button below you will be submitting your Online Service Application Form and accepting the Service Agreement outlined above. Please only click/submit once. You should be transferred to a confirmation page, and you will receive a detailed confirmation email of your submission. We strongly recommend that you save that confirmation email for your records.