Your Full Name:
Daytime Phone :
Name of Your School/Program/District:
Location (City and State):
Please tell us about your students. What is the predominant student culture? (i.e., geographic location, ethnicity, family income, language, etc.) For example, are your students mostly from lower or higher income families, students needing intervention or advanced programs, and any other information you can provide. The more information you can give us, the more it helps us choose appropriate stories and sets for you.
What is the instructional setting in which the materials would be used? (For Example, supplemental in the classroom, Intervention, Advanced Learners, ESL/ELD, Special Ed., Summer School, Before/After School, etc.)
Number of classrooms or groups:
Approximate number of students:
Do you have a budget restriction? We'd like to meet your budget needs, so please feel free to reveal your actual spending limit for this potential order.
What would be the source of your funding? (Title One, Reading First, 21st CCLC, State funds, School funds, PTA, Local Grant, Teacher, etc.)
When would you be potentially purchasing the Reader's Theater materials?
Anything else you would like to tell us: