PLANTS Off-Farm Lesson Request
CCUA’s PLANTS Program engages learners of all ages in hands-on experiences that emphasize the connection between food, health, and the environment. The PLANTS Program experiences take many forms and engage all ages in hands-on experiential learning to develop a deeper understanding of the social, cultural, environmental and economic impact of food on our communities. School, civic, and community groups can learn about the connection between food, health and the environment through our interactive lessons. We hope to empower and inspire learners to take skills acquired through the PLANTS Program and implement them in their homes, schools or workplaces.

CCUA charges a fee of $7 per student to facilitate lessons at an organizations site.

Group Name *
Your answer
Coordinator Name *
Your answer
Coordinator Phone Number *
Your answer
Coordinator Email *
Your answer
Site Address *
Your answer
Brief description of your groups mission and values *
Your answer
What is your goal in having CCUA facilitate a lesson with your group? *
Your answer
Preferred Date of First Visit *
MM
/
DD
/
YYYY
Preferred Time of First Visit *
Time
:
Backup Date of First Visit *
MM
/
DD
/
YYYY
Backup Time of First Visit *
Time
:
Would you like our educators to visit your site multiple times? *
How frequently?
Your answer
Please provide a list of your preferred dates and times for these future events.
Your answer
We teach a wide variety of subjects at CCUA. Please select from the following list which topics you would like covered during your visit(s) *
Required
Number of Participants *
Do not include adult teachers, group leaders, chaperones, or volunteers.
Your answer
Age range of participants *
Your answer
Number of Adult Group Leaders / Chaperones / Volunteers *
Your answer
We understand that not every organization has the funds to have our educators visit their site. Depending on our current grant funding we may be able to offer financial aid to certain organizations. Would you like to be considered for financial aid?
Is there anything else you would like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Columbia Center for Urban Agriculture. Report Abuse - Terms of Service