Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

2021/2022 Classroom Program Request Form

  1. Fill out this form to request a Classroom Program through the CCWD Water Education Program.

    The CCWD Water Education Program is going virtual for the 2021/2022 school year. We will revisit the possibility of in-person programs when County Health Orders indicate it is safe to do so.

    This form serves two purposes:

    1. To sign up for a virtual Classroom Program for the 2021/2022 school year.
    2. To provide feedback on in-person program accommodations, which will help us best prepare for future in-person programs.  

    Please note: Classroom Programs are available for 3rd, 4th, and 5th grade classes.

  2. Are you signing up for multiple teachers?*
  3. Title I School
  4. Note: For virtual programs, we have found it beneficial for learning to cap virtual classroom programs to no more than 40 students, so if you have four grade-level classes, we would recommend four classroom programs.

  5. How will students participate?*
  6. Preferred days of the week
  7. Preferred months of the school year
  8. If you have the option of either virtual or in-person programs during the 2021-22 school year, which do you prefer?*

    Note: Only one classroom program is available per class per school year; a class can participate in either one virtual program or one in-person program.

  9. Key Points
    • You will be contacted by CCWD to schedule programs.
    • Questions about scheduling or programs? Email CCWD Water Education.
    • Program duration is 60 minutes.
    • Program format: We ask that you make our instructors a temporary host on your account so they can conduct the program, share their screens, etc.
    • Please select the option to email yourself a copy for your records below and submit the form.
  10. Leave This Blank:

  11. This field is not part of the form submission.