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.

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* 1. School Name

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* 2. School District

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* 3. Is your school Title I?

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* 4. Please select the category that best describes your school classification below:

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* 5. Contact Name (First & Last)

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* 6. Contact Position

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* 7. Contact E-mail Address

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* 8. Contact Phone Number

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* 9. School Mailing Address

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* 10. City, State

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* 11. Zip Code

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* 12. Grade level(s) you will share this resource with:

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* 13. Estimated number of students you will share this resource with:

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* 14. Please describe how you plan to use this video resource:

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* 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."

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* 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.

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