Outreach: Virtual Request Form

Contact Information

Contact Name *

First

Last

Contact Email *

Contact Phone *

School / Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Does your school receive Title 1 funds? *

Yes
No

*Your school may be grant recipient eligible

Outreach Requests Info

Dropdown *

Total # of Students *

Total # of Adults *

Special Education Accommodations Needed?

Does Your School Receive Title 1 Funds? *

Yes
No

*Your school may be grant recipient eligible

Outreach Requests

Outreach Date / Time Preference 1 *

Date

Time

Outreach Date / Time Preference 2 *

Date

Time

Outreach Date / Time Preference 3

Date

Time

Outreach Date / Time Preference 4

Date

Time

Full descriptions and grade levels found in our Educator's Guide at (www.MindStretchingFun.org)

WOW Stage Shows: (30-45 minute shows held in classrooms or auditoriums for up to 150 students at a time)

You may select multiple WOW Stage Shows.
$10 per students per performance.

Learning Labs: (30-45 minute classroom programs held for up to 24 students at a time)

You may select multiple Learning Labs.
$10 per student per Lab.

Pre-K / Kinder Learning Lab Packages: (Each Package includes 4 30-45 minute labs designed for Pre-K / Kinder students up to 24 students at a time)

You may select multiple Packages.

$40 per student per package.

The Four Seasons -

What's in the Sky -

Life Cycles -

Measuring Up -

*Requests are not guaranteed Outreach Reservations.

Outreaches are only guaranteed once a signed contract and deposit have been received.

If you have any questions, please contact Rob Gilmore, Guest Services Director, at bookit@scitechdiscovery.org, or call us at (972)-546-3050 x 106.

Name of Person Making Request *

First

Last

Today's Date: *

Notes: