Town Hall Learning Experience Request Form

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Please correct the field(s) marked in red below:

PLEASE NOTE: This Request form is a public record under North Carolina law and will be shared with others upon request.

1
Please complete the following information:
 *
Please complete the following information:
2
3
Number of students per class:
 *
4
Please select your preferred dates to visit. The clerk’s office will contact you with alternate dates if your preferences are not available.
Please select your preferred dates to visit. The clerk’s office will contact you with alternate dates if your preferences are not available.
5
Are the students currently studying local government? If yes, please provide a brief description.
6

Your group(s) may be able to participate in the following additional activities. Please choose up to three and the Clerk's office will notify you of availability.

Each is approximately 20-30 minutes in length. 

If you choose multiple activities your class will be split into smaller groups. Classes will rotate to the different locations on campus. Each is approximately 20 to 30 minutes in length. Please allow two hours for the entire program. 

Your group(s) may be able to participate in the following additional activities. Please choose up to three and the Clerk's office will notify you of availability. Each is approximately 20-30 minutes in length. If you choose multiple activities your class will be split into smaller groups. Classes will rotate to the different locations on campus. Each is approximately 20 to 30 minutes in length. Please allow two hours for the entire program.
  1. To receive a copy of your submission, please fill out your email address below and submit.