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  Required fields are labelled in bold.

Teacher's Name:
Grade(s) taught:
School:
Home Address:
City:
State:
Zip Code:
E-mail:
Home Telephone:
School Telephone:
Local Cable System (if known):
Fax:

 

Name of project or unit (if appropriate):

Brief description of Project or Unit and how it was implemented in class:

Please list the A&E or History Channel program(s) you used and how they fit in to your unit or project:

Don't forget to mention other materials you used in support of this project or unit. Thanks! Material(s) I used: