College or School:

Department:

Faculty member name:

Faculty member email:

Course Title and Number:

Date and Time Requested:

Location:

Number of Students in Class:

Classroom capacity:

Relevant Texts Being Studied:

What would you like the actor to do in your classroom? If you request the actor to work with texts other than the current production, please provide a brief description.

Is there any other required or optional class work in connection with the residency?

How will the students be prepared for the class visit?