Nature in the Classroom Form - Irvine Nature Center

SCHOOL or ORGANIZATION*

NAME OF SCHOOL OR ORGANIZATION

SCHOOL MAILING ADDRESS*

SCHOOL ADDRESS

PROGRAM ADDRESS (if different from above)

PROGRAM ADDRESS (if different from above) For all VIRTUAL presentations, enter VIRTUAL

SCHOOL LOCATION*

Baltimore City
Baltimore County
Carroll County
Harford County
Howard County
Other

SCHOOL LEVEL*

PreK
Elementary
Middle
Other

TYPE OF SCHOOL*

Public
Private
n/a

IS YOUR SCHOOL TITLE 1?*

Yes
No

CONTACT NAME*

CONTACT NAME - First and Last

CONTACT EMAIL*

CONTACT EMAIL

CONTACT PHONE*

CONTACT PHONE

GRADE*

GRADE LEVEL

Expected Number of Students*

EXPECTED NUMBER OF STUDENTS (Topics labeled as "Presentation" do not have a maximum capacity; topics labeled as "Lesson" have a maximum capacity of 30.)

Number of Students with IEP or 504*

How many students have an IEP or a 504 plan?

NATURE IN THE CLASSROOM THEME*

NATURE IN THE CLASSROOM THEME: Select One

Start Time*

REQUESTED START TIME. (Earliest start is 9:30AM)

DURATION

REQUESTED PROGRAM DURATION, IF DIFFERENT FROM STANDARD (Standard Presentation is 1 hour; standard Lesson is 90 minutes.)

1st choice Date*

1st Choice Date (Mon-Fri only) PLEASE NOTE: This is not a guarantee. Your date request will be reviewed and confirmed via email by our Education Program Coordinator.

2nd Choice Date*

2nd Choice Date (Mon-Fri only) PLEASE NOTE: This is not a guarantee. Your date request will be reviewed and confirmed via email by our Education Program Coordinator.

3rd Choice Date*

3rd Choice Date (Mon-Fri only) PLEASE NOTE: This is not a guarantee. Your date request will be reviewed and confirmed via email by our Education Program Coordinator.

Special Needs/Accommodations

CAPTCHA

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