Please fill the following ^*

First Name ^*

Last Name ^*

Email (this email will be our primary form of contact with you) ^*

Phone Number (optional)

School ^*

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What is your role in your school? ^*

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Are you involved in the decision-making process at your school for adopting Cosmos? ^*

Yes

No

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How did you hear about Cosmos's pilot program? ^*

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Please provide the email you would like to have your Cosmos account affiliated with ^*

You will receive an invite to this email to create a Cosmos teacher account - we recommend using your school email. Please do not have any other Cosmos accounts with this email.

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How many different classes/groups of students will you be using Cosmos with? ^*

For example, if you use Cosmos for 2 history classes you teach, an english class, and for your debate team, this would be 4 different classes/groups of students

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What is the 1st class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 2nd class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 3rd class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 4th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 5th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 6th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 7th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 8th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 9th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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What is the 10th class/group of students you will be using Cosmos with? ^*

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Approximately how many students are in this class/group? ^*

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I agree to regularly update Cosmos on how my students and I are finding the pilot and provide any feedback we have ^*

I agree

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Do you have any comments, ideas, or unique situations you would like to share with the Cosmos Team before beginning this pilot?

/

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Thank you! 🙌

If accepted, within the next 24 hours you will receive an email from [email protected] inviting you to create a teacher account. You may now close this window.

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Pilot Request Form

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