Outreach: Virtual Request Form - Sci-Tech Discovery Center

Contact Name *

First

Last

Contact Email *

Contact Phone *

School / Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Dropdown *

Total # of Students *

Total # of Adults *

Special Education Accommodations Needed?

Does Your School Receive Title 1 Funds? *

*Your school may be grant recipient eligible

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: (45 minute shows held in classrooms or auditoriums for up to 250 students at a time) *

You may select multiple WOW Stage Shows. Please let us know if they are for different grades/dates.

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

You may select multiple Learning Labs but please let us know if these are for differnt grades/dates.

*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.

Today's Date: *

Notes: