Field Program Request Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required CONTACT INFORMATION Teacher First Name * Teacher Last Name * Email * Phone * School * Address 1 Address 2 City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code ABOUT YOUR CLASS Grade level * Number of students * Transportation to site (walking, bus, carpool, etc) * Would you like to request a transportation scholarship? (yes/no) Does your school include a large percentage (over 50%) of students eligible for the federal free and reduced price meal program? * Are there any special considerations our educators should be aware of to best serve your students? Which field program would you like to request? Wetland Walk (Grade 3) (Offered Tues, Thurs) Nature Rangers (Grade 4) (Offered Wed, Fri) Watershed Walk (Grade 5) (Offered Wed, Fri) Environmental Stewards (Grades 9-12) (Offered Fri) Preferred Date * Alternate Date * Classroom Presentation and Kit Upon submission of your field trip request, your class will automatically be scheduled for a Classroom Presentation ($25) and Classroom Kit Rental ($15) one week before your field trip. This is the recommended configuration to maximize the impact of the full program. Please indicate if you would like to decline your classroom presentation or kit rental. If having the Classroom Presentation one week in advance of your trip will not work with your schedule, we may be able to offer another date upon request.