Teacher Program Request Questionnaire
Are you interested in planning a field trip for a group of students to the NC Estuarium or the Roanoke/Cashie River Center? Step one is filling out this short questionnaire and submitting it! We will respond to you as soon as we are available to schedule a date. 
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Where would you like to take your group of students? *
What is your school or organization's name? *
What is your school or organization's phone number? *
Lead Contact Name *
Lead Contact Cell Number (this number will be used for the day of the program, if needed) *
Contact Email Address *
Address of school/organization
City, State, Zip Code *
County *
Requested Dates (please include 3 dates - NOTE: We are closed on Mondays) *
Arrival Time *
Time
:
Departure Time *
Time
:
Number of students *
Grade(s) of students *
Required
Number of teachers (for every 10 students, one teacher is required) *
Are there any students with special needs in your group? Please let us know what accommodations they will need. *
Are there certain NC Standards you would like our program to meet?
Are there any offerings that you want to be sure is included in your group's trip? If so, please check below:
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