University or research visits University or research appointment form Δ LinkedInThis field is for validation purposes and should be left unchanged.Are you...?(Required) UW-Madison affiliated Other university or college Individual scholar Other Visit type(Required) Class/group visit in the collection or exhibition galleries Class/group collections visit in the study rooms Individual or small group research appointment in the study rooms Engagement options My visit will be fully self-guided I would like an introduction from Chazen staff and can take it from there I would like to co-teach with Chazen staff I would like Chazen staff to lead the visit I’m not sure. Can we discuss? Date and time of visit:First choice date(Required) Month Day Year First choice start time(Required) Hours : Minutes AM PM AM/PM First choice end time(Required) Hours : Minutes AM PM AM/PM Second choice date(Required) Month Day Year Start time(Required) Hours : Minutes AM PM AM/PM End time(Required) Hours : Minutes AM PM AM/PM Third choice date Month Day Year Start time Hours : Minutes AM PM AM/PM End time Hours : Minutes AM PM AM/PM If additional dates are needed for repeat visits or multiple sections of the same course, please list below:CONTACT AND GROUP INFORMATIONName(Required) First Last Email address(Required) Phone numberDepartment (if UW–Madison):School name (if not UW–Madison):Number of people(Required)Course title and numberCONTEXT OF VISITWhat are your goals for this visit?(Required)Please include curricular themes, learning objectives, skill-building, and/or related assignments, as applicable.What would you like to see?List any specific galleries, exhibitions, or artworks you would like to see. Be sure to include the artist, title of the work, and the accession number (e.g. Romare Bearden, Circe, 2014.1). If you're not sure, Chazen staff can help.Would you like to meet with a Chazen staff member to help plan your class session?(Required) Yes No Are there any special needs or accommodation requirements in your group?Any additional comments or questions?This field is hidden when viewing the formTime Hours : Minutes AM PM AM/PM