Request Form
Date:
Please enter some information so that we may contact you. Once you have completed this form, hit submit to send it to your CaliQity representative.
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Required information
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County:
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District or Organization:
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School Name:
This will appear as the official, visible title of you CaliQity school
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Street Address:
Street Address 2:
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City:
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State/Province:
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Zip/Postal Code:
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Time Zone:
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Name:
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Title:
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Telephone:
ext:
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E-mail:
How are you wanting to use CaliQity:
I want to get in and play/demo the system
I want to use Caliqity to help me with delivering/supplementing instruction or professional development
I would like to set up an instance of CaliQity for my county/district/school
Describe any past experience with online learning
(optional)
What are your goals, plans, or needs, with regards to CaliQity?
(recommended)
