NatSci Junction Education Program Request Form
by E-Corps Expeditions

To schedule a program for your class or group, please complete the form below.

So for $96 you receive 90 minutes which may be divided into:
2 - 45 min sessions (15 minute break between sessions)
or 3 - 30 minute sessions
to accommodate groups of 30 participants/ a classroom
Programs scheduled in the 3 x 30 minute sessions require 10 minute break to reset for next group.

Our education programs incorporate the elements of Nature and Science;
along with a sense of place and critical thinking skills. For ages 8 -13 or grades 3 - and up.

Organization Name *
Please enter the name of the organization or person requesting a program
Your answer
Contact Name *
Please enter name of person to contact.
Your answer
Email address *
Please enter contacts email address for all corresspondence.
Your answer
Telephone Number *
Enter contact telephone number with applicable extension.
Your answer
Alt Telephone Number *
Enter contact telephone number with applicable extension.
Your answer
Mailing Address *
Please enter mailing address for all correspondence include street, city, state and zip code.
Your answer
Organization Physical Address*
Please enter physical address (if different from the mailing address) of the organization, include street, city, state and zip code.* If more than 25 miles from E-Corps ELC mileage is $0.51 a mile
Your answer
Program Date Requested *
Enter your requested program date and start time, every effort will be made to meet this program date.
MM
/
DD
/
YYYY
Time
:
Second Choice Program date and start time *
Please select this date as an alternative.
MM
/
DD
/
YYYY
Time
:
Third Choice Program date and start time *
Please select this date as a second alternative
MM
/
DD
/
YYYY
Time
:
Number of Students (participants) *
Please enter class size is group size is over 12 for an outdoor activity - chaperones must be provided by requesting organization
Your answer
Grade level & Age Group *
Please select age group(s) or grade level(s) that apply to your request.
Required
Program Topic Request K-8 *
Please select program focus desired
Required
Please select the class size *
Additional programs may be added for a discounted rate and Qualifing organization may be entiled to a 20% discount see below
Required
Program Site Address
Please enter physical address of the location for program to occur, include street, city, state and zip code.
Your answer
School Category or District *
Please select your school category or district or location county
Please add any payment detail requirements
"Our school requires a invoice to issue a purchase order" Our programs required a deposit to be scheduled.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of E-Corps Expeditions. Report Abuse - Terms of Service
Google Forms