School Visit Request Form
Consulate General of Japan, Boston
SCHOOL VISIT PROGRAM
School Visit Request Form
The School Visit Program of the Consulate General of Japan in Boston is an educational outreach which sends staff and community volunteers to schools in the New England area to make presentations about Japan and conduct cultural workshops. Sessions usually last about an hour and are provided free of charge.
To schedule a session at your school, please have the classroom teacher or administrator who will oversee the session fill out the following information. We will try to accommodate as many requests as possible, however, please note that because of our limited number of staff and volunteers, we may not be able to accommodate all requests. To facilitate communication, we ask that you provide as much contact information as possible, including an e-mail address, telephone number and fax number.
I. School Information:
Name of School: _____________________________________________________________________
Name of Educator: ____________________________________________________________________
Position in School: ____________________________________________________________________
School Address:______________________________________________________________________
________________________________________________________________________
Daytime phone number: ( )________________________ Fax: ( ) _________________________
E-mail address: _______________________________________________________________________
Grade Levels in School: K 1 2 3 4 5 6 7 8 9 10 11 12 (Please circle all that apply.)
Requested Dates & Times: 1st choice __________ 2nd choice ___________3rd choice ___________
Class or Group Size (Please limit to 45 or less): _________________________________
Grade Level(s): _________________________________ Subject: __________________
Students?f background knowledge about Japan (information covered, materials used, etc.):_________________________________________________________________________________
Recent topics, unrelated to Japan, studied (to facilitate possible curriculum tie-ins): ____________________________________________________________________________________
DVD Player Availability: Yes No
Projector Availability: Yes No
II. Content of Presentation:
(Please write your preference on the content of the school visit to your school so that we can tailor it to meet the interests of your students.)
a. Topics of Interest About Japan (e.g. school life, family life, customs, language, holidays and celebrations, traditional games and toys, etc. _____________________________________________________________________________________
b. Activities (Please rank the following activities in order of preference.):
Japanese Language Lesson: _____
Japanese Writing Lesson: _____
Origami Workshop: _____
Japanese Toys and Games Workshop: _____
Other (_______________________): _____
c. Special Requests/Considerations (Please share any special requests or considerations you or your students might have.
______________________________________________________________________________
To facilitate scheduling, all requests should be made at least
two weeks to one month in advance of presentations.
For more information, please contact 617-973-9772 ext. 138. To request a visit, please complete and fax this form to 617-542-1329 ATTN: Sumiko Otsuka, or mail it to Consulate General of Japan, Federal Reserve Plaza, 22nd Floor, 600 Atlantic Ave., Boston, MA 02210, ATTN: Sumiko Otsuka. Alternately, you may email all information to infocul@bz.mofa.go.jp.