STEM Experts Reservation Request Form (K-12)
* Required
We get it – leaving campus is hard sometimes. STEM Experts is a unique opportunity in which the CMSE helps bring STEM Faculty and/or Ambassadors to a classroom for engaging lessons, dynamic demonstrations, and/or intriguing lectures. Through this offering, the CMSE will identify a STEM Faculty/Ambassador and act as a liaison between the STEM Faculty/Ambassador and the teacher.
Contact Information
First Name
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Your answer
Last Name
*
Your answer
Preferred Email Address
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This will be the email address that will be used to contact you.
Your answer
Any other email address(es) that should be cc'ed
Your answer
Cell Phone Number
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This number will ONLY be used for day of excursion, if needed. Please use this format: XXX-XXX-XXXX.
Your answer
School/Group Information
Your role at school/group
*
(Classroom Teacher, Principal, Science Coordinator, etc)
Your answer
School/Group Name
*
Your answer
School/Group District
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Your answer
School/Group Phone Number
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Please use this format: XXX-XXX-XXXX.
Your answer
School/Group Mailing Address
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Your answer
City
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Your answer
State
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MS
Other:
Zip Code
*
Your answer
County
*
Your answer
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