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Name of Organization or School *

Applicant Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Has your organization or school been to the Deerassic Park Education Center in the past? *

Yes
No

If yes, date(s) of previous trip(s): *

Has your organization or school ever hosted Deerassic Park at your facility before? *

Yes
No

If yes, date(s) of previous visit(s): *

How many students/children are you expecting for this in-class visit? *

What benefits will your students receive from this classroom lecture/activity? *

What circumstances or reasons does your school district need the funding? *

How will this in-class visit integrate into your current curriculum? *

During this visit, are you looking to do just one activity (approx. 45 minutes-1 hour) or is this something you're looking to make a "field day" out of it with multiple stations going on in multiple classrooms/areas of the school where your students would be split into groups to rotate around during the school day? *

Did you have any activities in mind for this visit after looking at our In-Class Program Options List? *

Signature *

Clear Signature

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