Domes Virtual Field Trip Request Form
Thank you for your interest in a virtual science class with the Friends of the Domes!

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Group Type *
School/Organization Name *
City *
Zip Code *
Group Leader/Teacher's Name *
Group Leader's Cell Phone *
Group Leader's Work (or Other) Phone *
Group Leaders Email(s) *
Please include all adults who are attending, or who should be included in email communication, separated by commas
Administrator Email (To Send Invoice) *
Grade Level(s) of Children/Youth Attending *
Estimated number of Children Attending *
Would you like to apply for a scholarship to cover the cost of your experience?
We currently have grant funding available for virtual programs. Qualification is based on the DPI School Report Card - Student Groups - Percentage of Economically Disadvantaged Students.  If you choose "Yes", an FOD staff member will be in contact with you via email within the week. Please note - if you've already been contact that you've been awarded a scholarship, you may leave this question blank.
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Any specific learning or accessibility needs for this virtual workshop?
Program Experience Choice *
Your learning objectives for this experience (if any):
Any additional comments regarding programming or curriculum preferences?
Day of the Week Preferences
Check the day(s) that would work for your a field trip
Morning or Afternoon Preference?
Please note that the Domes are typically less busy in the morning
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Important Time Considerations
I.e. times that definitely would work or would not work.
Specific Dates You Are Interested In Scheduling:
Please list dates separated by commas, in order of preference. Note: we may not be able to accommodate specific requests. 
Is there anything else you would like us to know?
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