Outreach Visit Request Form

Our outreach programs are offered on Wednesdays throughout the year to groups within 75 miles of Washington-on-the-Brazos State Historic Site. Reservations must be made 6 weeks in advance.

Outreach programs can be modified to fit auditorium style programming or individual classroom style experiences. Only one outreach program can be scheduled at a time, however, multiple sessions of the outreach program can be scheduled on the same day by the same school.

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Organization Name *
Is this a K-12 School? *
Address *
City *
State *
Zip *
Contact Person *
Email *
Telephone Number *
Grade Level(s) *
Total Number of Students *
Program Title *
Preferred Date - Wednesdays Only *
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Second Choice Date  - Wednesdays Only *
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Third Choice Date  - Wednesdays Only
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Program Start Time (9:30 is the earliest time to begin) *
Time
:
Departure Time *
Time
:
Type of Session *
Number of the above Sessions *
If more than one session, please list the expected start and end time for each subsequent session. For example:
Session 1: 9:35am to 10:27am
Session 2: 10:34am to 11:26am
*
Is there any information our Staff Members need to know about set up, tear down, or check-in procedures?
 I understand that payment is due one-week prior by check or credit card or the visit will be canceled. *
Required
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