Virtual Field Trip Request Form

Contact Information

Contact First Name *

Contact Last Name *

Contact Email *

Preferred Phone Number *

School Information

School/Institution Name *

School Address *

City *

State *

ZIP / Postal Code *

Group Information

Grade: *

Number of Participants *

Is this a Title 1 school? *

Yes

Program Choice *

Visit Information

Please enter two preferred dates (Tuesday-Friday)

Preferred Date

Preferred Time of Visit *

10:00am

11:00am

No preference

Both - my group requires two sessions

Any additional information we should know in advance?

Booking Requirement Note:

In lieu of payment, all participating teachers are required to participate in a post-program survey. The link to the survey will be emailed to the contact email provided after the program.