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Education Hub Sign-Up Form

Thank you for your interest in the Eugene Symphony's new Education Hub. After you fill out this form, we will contact you in a few business days with more information on how to access the platform.

If you need assistance filling out this form, please contact Education & Community Engagement Director Katy Vizdal at katy.vizdal@eugenesymphony.org or call (541) 687-9487 x1116.
1.School Name(Required.)
2.School District
3.Is your school Title I?
4.Please select the category that best describes your school classification below:(Required.)
5.Contact Name (First & Last)(Required.)
6.Contact Position(Required.)
7.Contact E-mail Address(Required.)
8.Contact Phone Number(Required.)
9.School Mailing Address(Required.)
10.City, State(Required.)
11.Zip Code(Required.)
12.Grade level(s) you will share this resource with:(Required.)
13.Estimated number of students you will share this resource with:(Required.)
14.Please describe how you plan to use this video resource:(Required.)
15.Please indicate if you agree with this distribution stipulation: "I understand this video resource is for school educational purposes only, and I will not share this resource with the general public under any circumstances."(Required.)
16.Please list any additional questions or comments you have here:
Thank you for signing up for Eugene Symphony's Education Hub resource. You will receive an e-mail with further details in the next couple of days. For questions or comments, please contact Education & Community Engagement Director Katy Vizdal at katy.vizdal@eugenesymphony.org or by phone at (541) 687-9487 x1116.