Teachback requests must be submitted a minimum of 3 WEEKS in ADVANCE in order to be scheduled. Please check your calendar to ensure you are abiding by this procedure before proceeding with your request. ALL CANCELLATIONS once Teachback is scheduled, must be received NO LATER THAN 3 business days before Teachback. Cancelled Teachbacks will not be counted toward the minimum "Parent Event Activity". 

If you have questions, please contact Quincy Stone (qstone@psesd.org) or Cammy Ariola-Moku (cariola_moku@psesd.org).

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* 1. Name (Staff person comleting this form)

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* 2. Email Addess (Staff person completing this form)

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* 3. Phone # (Staff person completing this form)

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* 4. Center / Site

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* 5. Select your Center/Site's programs

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* 6. What is the location of the Teachback?

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* 7. Select the Teachback opportunity you are requesting

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* 8. Select the type of Teachback you're requesting

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* 9. Select the language(s) for the Teachback you're requesting (check all that apply)

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* 10. Select a date & time of the Teachback (minimum 3 weeks notice)

Date
Time

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* 11. Do you have a trained parent at your site?

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* 12. If yes, name

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* 13. How many English-speaking families will be attending?

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* 14. How many Spanish-speaking families will be attending?

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* 15. Are there other languages needed other than English or Spanish? If yes, please list them here, with the number of families attending.

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