Trunk Loan Request: Private Schools

The Holocaust Learning Trunk Project is available to middle school educators in Georgia. In order to request a trunk to use in your classroom, please complete and submit the form below. You and a school administrator are also required to agree to the Loan Terms and Requirements.

Once this request form is submitted, a staff member will contact you via phone or email to confirm availability and to make arrangements for the delivery of the trunk. You will also receive an automatic email with instructions on how you can prepare for the arrival of the trunk.

Introduction

Agencies, schools, or districts requesting a trunk must meet the following criteria:

signed approval from school or district administration
make the trunk and the contents available only to middle school educators and students
designate a single contact person responsible for maintaining the trunk, contents, and tracking data
provide complete tracking data for the use of the trunk and the contents by educators and students to the Commission

Preference will be given to schools or districts that meet any of the following:

Title 1 designation
classification as a charter school
do not currently have a trunk already available in school districts immediately adjacent
include educators that have attended an educator workshop or presentation provided by the Commission within the past 24 months
include educators that have made a commitment to attend an educator workshop provided by the Commission within the next 18 months

I have read and understand the criteria listed above.

School Information

The school will be the host facility during the loan of this trunk.

School Name (required)

School Address (required)

School Phone (required)

School Fax (required)

Educator Information

This is the educator completing this form and will subsequently be the contact for this loan.

Educator Name (required)

Educator Email (required)

Educator Primary Phone (required)

Educator Secondary Phone (required)

Subject(s) taught (required)

Grade Level(s) taught

If other educators at the school will be accessing and utilizing the trunk contents, please provide their names and e-mail addresses:

Media Specialist Information

The media specialist will be responsible for displaying the trunk in the media center and ensuring that the trunk contents are only removed from the trunk for use by educators in the school. These educators are also responsible for submtting the required online evaluation within 30 days of the end date of the loan.

Media Specialist Name (required)

Media Specialist Email (required)

Media Specialist Primary Phone (required)

Media Specialist Secondary Phone (required)

Trunk Request

Preferred date of arrival (required)

Preferred date of departure (required)

Approximate number of students (required)

This is the total number of students who will have access to the Holocaust Learning Trunk in your classroom.

If the request loan period exceeds 3 weeks, please provide information regarding the reason for an extension including:\nthe total number of educators that will access the trunk contents\ndetails about the special circumstances rendering the 3 week loan period insufficient

Have you or any of the educators included on this form attended any workshops presented by the Georgia Commission on the Holocaust?

yes

Have you or any of the educators included on this form registered for any upcoming workshops presented by the Georgia Commission on the Holocaust?

yes

Trunk Loan Request: Private Schools

Agencies, schools, or districts requesting a trunk must meet the following criteria:

Preference will be given to schools or districts that meet any of the following:

School Information

Educator Information

Media Specialist Information

Trunk Request

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