Section 1 of 1
Virtual Classroom/Club Visit Request Form
Use this form to request virtual classroom and club visits.
Name
Name
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Date
Time
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E-mail address
E-mail address
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Date
Time
Number
Text
Length
Regular expression
Contains
Doesn't contain
Email
URL
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Mobile phone number at which you can be reached:
Mobile phone number at which you can be reached:
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School or Institution
School or Institution
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Time
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Class or club for which you are interested in having a virtual visit
Class or club for which you are interested in having a virtual visit
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Multiple choice
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Date
Time
Answer key
(0 points)
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Topic or theme for which you are interested in having a virtual visit (check all that apply):
Topic or theme for which you are interested in having a virtual visit (check all that apply):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
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Checkbox grid
Date
Time
Cultural Expectations
What's in a Name?
Migration and Diaspora
Geopolitics
Science and Technology in a Global Context
Foodways and Colonialism
Other
Add option
or
add "Other"
…
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If you selected "other" above, in which topic or theme are you interested in having a virtual visit?
If you selected "other" above, in which topic or theme are you interested in having a virtual visit?
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Multiple choice
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File upload
Linear scale
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Checkbox grid
Date
Time
Answer key
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Online platform which your school is using this year:
Online platform which your school is using this year:
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Date
Time
Microsoft Teams
Schoology
Zoom
Google Classroom
YouTube Live
Facebook Live
Other
Add option
or
add "Other"
…
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In which format are you interested in having the virtual visit?
In which format are you interested in having the virtual visit?
Question Type
Short answer
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File upload
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Checkbox grid
Date
Time
Pre-recorded activity
Livestream visit
Add option
or
add "Other"
…
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If you are interested in the livestream option, please indicate the day of the week (or actual date) and time, including time zone.
If you are interested in the livestream option, please indicate the day of the week (or actual date) and time, including time zone.
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Date
Time
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Venue for which you are interested in having a virtual visit:
Venue for which you are interested in having a virtual visit:
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Multiple choice
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Dropdown
File upload
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Multiple choice grid
Checkbox grid
Date
Time
Student club
After school care program/camp
Classroom
Other…
Add option
…
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(0 points)
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Are you interested in having a presentation in another language?
Are you interested in having a presentation in another language?
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Date
Time
No
Yes
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or
add "Other"
…
Answer key
(0 points)
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If you are are interested in having a presentation in another language, please indicate which language.
If you are are interested in having a presentation in another language, please indicate which language.
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Multiple choice
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File upload
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Checkbox grid
Date
Time
Answer key
(0 points)
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Are you interested in having a particular UCIS unit provide the presentation for your virtual visit?
Are you interested in having a particular UCIS unit provide the presentation for your virtual visit?
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Short answer
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Date
Time
Yes
No
Not sure
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or
add "Other"
…
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If you are interested in having a particular UCIS unit provide the presentation for your virtual visit, please indicate which unit:
If you are interested in having a particular UCIS unit provide the presentation for your virtual visit, please indicate which unit:
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Short answer
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Multiple choice
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File upload
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Checkbox grid
Date
Time
African Studies Program
Asian Studies Program
Center for Latin American Studies
Center for Russian, East European and Eurasian Studies
European Studies Center
Global Studies Center
Nationality Rooms and Intercultural Exchange Programs
Add option
or
add "Other"
…
Answer key
(0 points)
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Are you amenable to having a Pitt graduate or undergraduate student virtually present to your students?
Are you amenable to having a Pitt graduate or undergraduate student virtually present to your students?
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Short answer
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Multiple choice
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File upload
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Checkbox grid
Date
Time
Yes
No
Maybe
Add option
or
add "Other"
…
Answer key
(0 points)
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Is there anything else you would like to share with us?
Is there anything else you would like to share with us?
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Date
Time
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