Education Program Request Form

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This is an Education Program REQUEST. We will contact you within one week to confirm your scheduled program date(s).

School or group name: Low Income?

Teacher or group leader:

Email: Phone:

Address:

How did you hear about us?

Expected Number of Students: Grade/Age Level: Expected Adults (1 free for every 10 students):

Please note programs are available Tuesday-Friday, 9 a.m.-4 p.m.

1st Choice Date:  
2nd Choice Date:
Time:  
Time:

Length of visit: Have you visited the museum before? Yes No
(60 minutes for 2nd and younger, 90 minutes for 3rd grade and higher)

SCHOLARSHIP APPLICATION SUBMITTED?                YES NO (Separate form)
TRANSPORTATION SCHOLARSHIP REQUEST?     YES NO (up to $100)

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

List any educational goals or subjects of interest.

Program Options: (choose one)

Grades PreK - 2nd
Storm Boy
Fun with Fossils
Camas Oven
Animal Tracks
Grades 6th - 8th
Cultural Scene Investigation
Adapt, Move or Go Extinct
Ride the Rock Cycle
Grades 3rd - 5th
Oregon Archaeology Detectives
The Famous Fossil Find
Adapt, Move or Go Extinct
Ride the Rock Cycle
Grades 9th - 12th
Cultural Scene Investigation