Virtual Science Live Request Form
Thank you for your interest in a virtual science class with the Friends of the Domes!

For information, please visit www.milwaukeedomes.org/childrens-programs
INFORMATION ABOUT YOUR GROUP:
Group Type *
School/Organization Name *
Address
City *
Zip Code *
Group Leader/Teacher's Name *
Group Leader's Cell Phone *
Group Leader's Work (or Other) Phone *
Group Leaders Email(s) *
Please include all adults who are attending, or who should be included in email communication, separated by commas
Administrator Email (To Send Invoice) *
Grade Level(s) of Children/Youth Attending *
Required
Preferred Delivery Method:
Clear selection
Number of Children: *
Would you like to apply for a scholarship to cover the cost of your experience?
We currently have grant funding available for virtual programs. Qualification is based on the DPI School Report Card - Student Groups - Percentage of Economically Disadvantaged Students. If you choose "Yes", an FOD staff member will be in contact with you via email within the week. Please note - if you've already been contact that you've been awarded a scholarship, you may leave this question blank.
Clear selection
Any specific learning or accessibility needs for this virtual workshop?
PROGRAMMING:
Program Experience Choice *
Your learning objectives for this experience (if any):
Any additional comments regarding programming or curriculum preferences?
SCHEDULING
Day of the Week Preferences
Check the day(s) that would work for your a field trip
Morning or Afternoon Preference?
Please note that the Domes are typically less busy in the morning
Clear selection
Important Time Considerations
I.e. times that definitely would work or would not work.
Specific Dates You Are Interested In Scheduling:
Please list dates separated by commas, in order of preference. Note: we may not be able to accommodate specific requests. Programs available after 5/24/21
Is there anything else you would like us to know?
Submit
Never submit passwords through Google Forms.
This form was created inside of Friends of the Domes, Inc.. Report Abuse