STEAM Night Request Form (Sci-Tech At Your School)

Contact Information

Contact Name *

First

Last

Contact Email *

Contact Phone *

School / Organization *

School District *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you 15 miles or further from Sci-Tech? *

No
Yes

Miles from Sci-Tech *

Estimated Mileage Cost

Title One Sponsorship Opportunity

Does your school receive Title 1 funds? *

Yes
No

*Your school may be grant recipient eligible

What percentage of your school is low income?

More than 40%
Less than 40%
Unsure

STEAM Night Request Info

*Estimates are ok!

Grade Level(s) *

Total # of Students *

Special Accomidations Needed? *

Yes
No

What Special Education Accommodations Needed?

Outreach Requests

Outreach Date / Time Preference 1 *

Date

Time

Outreach Date / Time Preference 2 *

Date

Time

Outreach Date / Time Preference 3

Date

Time

STEAM Night Packages include 2 Sci_Tech Staff Members for 2 hours. If you would like to inquire about additional time or activities please do so in the note section.

Additional Activity: (added cost)

Additional Table Top Activity ($250)
Additional WOW! Show ($350)

Today's Date: *

*Requests are not guaranteed Reservations.

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

If you have any questions, please contact our booking department at bookit@scitechdiscovery.org, or call us at 469-896-2188 X2.

Notes: