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Evening of Play
In-Person Outreach Interest Form
I AM SCHEDULING:
IN-PERSON OUTREACH (visit)
VIRTUAL OUTREACH (Zoom)
THIS FORM IS FOR IN-PERSON OUTREACH VISITS ONLY. IF YOU ARE TRYING TO SCHEDULE A VIRTUAL OUTREACH, PLEASE RETURN TO THE OUTREACH PROGRAMS PAGE AND SELECT THE VIRTUAL FORM.
Name of organizer
*
First
Last
Email
*
Phone
*
Institution
*
Are you a Title I institution
Yes
No
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Grade level
*
Select all that apply. Use the Control key to select more than one.
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
Number of children
*
Program desired
*
Pre-K/K: Wee Can Count
Pre-K/K: Colorful Kiddos
Pre-K/K: Beep Beep!
Pre-K/K: Marvelous Murals
K-3rd: Noisy Science: Sound
K-4th: That's Extreme
K-4th: Wonders of Water
1st-3rd: Wonders of Space
1st-3rd: Dino Discovery
1st-3rd: Amazing Murals
4th-5th: Messy Science: Reactions
4th-6th: Amazing Murals
Please select the program(s) you want us to present to your class during our virtual outreach. Use the Control key to select more than one. Grade designations reflect state standards met.
What language would you prefer for your program?
English
Spanish
Bilingual
Date - First choice
*
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
*
What time should we begin the outreach?
:
Hours
Minutes
AM
PM
AM/PM
Date - Second choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?
:
Hours
Minutes
AM
PM
AM/PM
Date - Third choice
Outreach programs are available Tuesday through Saturday. Please pick a date for our visit.
MM slash DD slash YYYY
Time
What time should we begin the outreach?
:
Hours
Minutes
AM
PM
AM/PM
Name
This field is for validation purposes and should be left unchanged.