Middle and High School Education Request Name First Last PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Organization/School Name Number of ParticipantsNumber of ClassroomsAge Range of Participants Grade Please briefly describe why you are applying for community outreach for HSSA and how it will be used in your program curriculum? Include how many children will likely be participating and what your expected outcome may be.Which Middle or High School education programs are you applying for below?Virtual Behind the Scenes Tour (grades 2 and up)Virtual Ambassador Ball Python Visitation (grades K and up)HSSA Overview (all ages) Required for all groupsBite Prevention and Safety Around Animals (grades 2 and up)How many is too many (grades 2 and up)Living with Urban Wildlife (grades 2 and up)Juvenile Animal Cruelty (grades 2 and up)Caring Careers (grades 2 and up)HSSA shelter tour (grades 2 and up)Community Service 2 part (grades 2 and up)Wild vs. Domestic (grades 2 and up)When Dogs were Wolves (grades 6 and up)When Cats were Wild (grades 6 and up)Pit Bull Myths and Dog Fighting Awareness (grades 6 and up)Animals in Entertainment (grades 6 and up)Ball Python Animal Ambassador Visitation (grades 2 and up)Pet VIP Therapy and Visitation Dog (grades 2 and up)Guinea Pig Animal Ambassador Visitation (grades 2 and up))Hold Control to select multiple programs.Program Visit Dates* Please provide dates, or date ranges for program visits.Requesting Teachers' Emails*Please provide the emails of all teachers that are requesting HSSAZ visits with each email on its own line.Please provide any additional COVID protocol our educators must follow for in person school visits.What platform is preferred for virtual visitation? By submitting this request, I understand that as part of the free school based education, my class will host a fundraiser or supply drive to benefit the pets at the HSSA. Yes, I would like to receive e-mail from Humane Society of Southern Arizona Yes, I would like to receive postal mail from Humane Society of Southern Arizona