Application for Outreach Visit
Please fill out the following form with as much detail as possible. Applications will be considered on the first Wednesday of each month. If you submit your application by the next monthly deadline, you can expect to hear back from the outreach committee within 5-7 business days of their meeting. Please keep in mind that applications need to be submitted at least 60 days in advance to allow time for review and planning. Due to the yearly on-campus outreach event Exploring Your Universe, which generally takes places on the first Sunday of November and is free to the public, our ability to fulfill requests is limited during Fall quarter due to volunteer shortages.

Contact Information
First Name *
Your answer
Last Name *
Your answer
E-mail Address *
Your answer
Phone Number *
Your answer
UCLA Contact
Your answer
School or Organization Name *
Your answer
School or Organization Address *
Your answer
Event Details
Would you like to visit UCLA or would you like our volunteers to come to your school? *
While we will review all applications, it is generally not possible for us to travel more than 25 miles from UCLA campus.
If you would like to visit to UCLA, can you provide your own transportation to campus?
Do you have a specific date for your request? *
If you are requesting a specific date, please make sure to enter the date below.
Please select a date for your outreach event. *
Please note that all applications should be made AT LEAST 60 DAYS PRIOR to the requested event. It is difficult for us to arrive before 10 am for transportation purposes.
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Please select a second date for your outreach event.
This option will only be used if we cannot accommodate your first date choice.
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Time
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Please include any additional availability details that may help us to better accommodate your event. Let us know If a specific day or time of the week is best.
Your answer
How many students would be participating in the event? *
Generally we can accomodate up to about 60 students in groups of 20.
Your answer
What is the age/grade of the students in your group? *
Your answer
How long would you like the outreach program to last? *
Programs are typically between 1 and 2 hours.
Your answer
Which activities would you like to see? Select all that apply. *
To see a list of available activities, please visit <planets.ucla.edu/outreach/outreach-activities/>
Required
If required, you would be able to provide:
Are you a Title 1 school? *
If you are not a Title 1 School, what other information can you provide about the diversity of your student body?
Your answer
Is there anything else we should know about your school or students? Let us know if your students are ESL learners or have special needs. If you have any other details or requests you would like to include in your application please list them here.
Your answer
If our program is not suited to your schedule or event what type of outreach did you have in mind?
We can help to connect you with other outreach resources on campus (Biology, Chemistry, Mathematics, etc)
Your answer
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