T1 Outreach Request Form

Request Form Purpose *

Begin Booking Process
Quote Inquiry

*Please note that if you choose Quote Inquiry then you will not be added to our booking calendar. If you choose to move forward after recieveing your quote then you will need to contact us via phone, email, or fill out a new form. Prefered dates will not be saved.

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

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

Outreach Requests Info

Outreach Type *

In Person (At your school)
Virtual

Please note that schools outside a 15 mile radius will be charged a travel fee.

Grade Level(s) *

Total # of Students *

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

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
$325 for the first performance, $200 for each additional performance

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

You may select multiple Learning Labs
$225 for the first Learning Lab, $175 for each additional Lab

*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 our booking department at bookit@scitechdiscovery.org, or call us at 469-896-2188 X2.

Today's Date: *

Notes: