Science on Wheels Assembly Registration Form
Please scroll down and fill out the form below to request a Science on Wheels assembly program visit from Roper Mountain Science Center.
If you would like to request a Starlab visit instead, please go to the website below and click the registration link there:
https://www.ropermountain.org/main.asp?titleid=starlabportplan
If you would instead prefer a public Science on Wheels program (good for library programs, Science Nights, camps and community events) please visit the website below and click the registration link there.
https://www.ropermountain.org/main.asp?titleid=sowpublic
If you have difficulty with this form, or if you do not yet have enough details to complete the request form, but would like to hold a date or get more information, please contact the Outreach Specialist, Jennifer Romatelli at
jromatelli@greenville.k12.sc.us
or 864-355-8940.
* Required
Your School Name
*
Your answer
Street Address of School
*
Please include the street address of your school. This is for driving directions, so no PO boxes please.
Your answer
City, State and Zip Code of School
*
Your answer
Main office phone number
*
Your answer
Name and title of requestor
*
Your name and title at the school
Your answer
Requestor phone number
*
best number to contact you
Your answer
Requestor email address
*
your email address
Your answer
How would you prefer we contact you?
phone
email
either
Name and title of person responsible for payment
*
Your bookeeper's name, or the name of whoever will process your payment (if you are requesting grant funding, just put N/A)
Your answer
Phone number of person responsible for payment
*
Phone number for the person in the previous question (if you are requesting grant funding, just put N/A)
Your answer
First Choice Date
*
Select your first choice date for the visit
MM
/
DD
/
YYYY
Second Choice Date
Select your second choice date for the visit
MM
/
DD
/
YYYY
Third Choice Date
Select your third choice date for the visit
MM
/
DD
/
YYYY
Location of Program(s)
*
In which room or space at your school will the program(s) take place? Space requirements are listed on the Science on Wheels website. Note, we cannot move assembly programs from one space to another UNLESS you choose the "Two Different Assemblies" or "I need something different" options below. Moving an assembly to a new location for multiple sessions will require additional time and may incur additional charges. If you do not know the location yet, please say you don't know.
Your answer
Assembly Format
*
Please select the type of schedule you are looking to reserve. If you want to combine short and long assembly lengths, you will select those options in the next section.
One session of a single assembly program
Two sessions of the same assembly program
Three sessions of the same assembly program
Two different assemblies (one session of each)
I need something different than these options
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