Classroom Outreach Program Request Form

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 Classroom Outreach Program Request Form

 

School/Organization:

School District:

Teacher/Leader:

Email: Phone:

Address:

City: Zip: County:

 

How did you hear about the MNCH outreach programs?

Are you applying for scholarship funds by submitting a Scholarship Application? Yes No
(Complete the Scholarship Application Form located below)

Scheduling Request – List one day or a set of consecutive days as your 1st and 2nd choice. Program times can be adjusted as needed once the dates are confirmed.

1st Choice Date(s):  

2nd Choice Date(s):

 

Program Options:

A. Ice Age Creature Features (Grades K-1)

B. Exploring Fossils (Grades 1-3)

C. Animals of Ancient Oregon (Grades 2-5)

D. Skulls and Bones (Grades 6-8)

E. Oregon's First Engineers (Grades 1-2)

F. Investigating Artifacts (Grades 2-5)

G. Adventures in Archaeology (Grades 6-8)

H. Rocks on the Road (Grades 4-5)
 

Day One

Group 1: Number of Students:   Grade:   Time:   Program:

Group 2: Number of Students:   Grade:   Time:   Program:

Group 3: Number of Students:   Grade:   Time:   Program:

Group 4: Number of Students:   Grade:   Time:   Program:

 

Day Two

Group 1: Number of Students:   Grade:   Time:   Program:

Group 2: Number of Students:   Grade:   Time:   Program:

Group 3: Number of Students:   Grade:   Time:   Program:

Group 4: Number of Students:   Grade:   Time:   Program:

Do any students have special needs of which the outreach educator should be aware?

Additional Information:

 


  Outreach Program Scholarship Application
   2018-19 School Year

 

The University of Oregon Museum of Natural and Cultural History is pleased to offer scholarships that will bring the Museum’s traveling education programs to classrooms throughout the state of Oregon. 

Guidelines and Eligibility:

  • Schools with at least 50% of students eligible for free or reduced lunch.
  • Scholarship funds will pay for 50% of outreach program fees, and may also be available to cover some or all travel expenses related to program delivery.
  • Applications must accompany an Outreach Program Reservation Form and be submitted two weeks before the desired program date.
  • The Outreach Program will review scholarship applications and you will be notified by email or phone within one week of submission.
  • Scholarships and program dates are awarded on a first-come, first-served basis starting September 1.

To apply for scholarship funding, complete the application below. 


Name of School:

Are at least 50% of students at your school eligible for free/reduced lunch? Yes No

Applying for: (check all that apply)

One Classroom Program
Multiple Classroom Programs (scheduled at same school), How many?:
Travel Expenses (for locations outside of the Eugene/Springfield area)

School District:

Teacher/Leader:

Email: Phone:

Number of participants:    Students: Adults: Grade level(s):