K-12 STEM Education Outreach Request Form

K-12 STEM EDUCATION OUTREACH REQUEST FORM

Would you like someone to come in and provide your classroom with STEM demonstrations, experiments, and activities? Would you like a scientist/engineer to speak to the students at your school about their career path and education? Please complete and submit the following request form.

POC/Teacher Name

School Name

School District

POC/Teacher Phone Number

POC/Teacher Email

School Address

City

State

Zip Code

School Website

How did you hear about us?

Website

Other…

Desired Event Date

Number of Participants

Grade Level of Participants

Elementary K-2

Elementary 3-5

Middle 6-8

High School 9-12

Please describe the program you desire

FILLING OUT THIS FORM DOES NOT GUARANTEE THAT NETL WILL BE ABLE TO ACCOMMODATE YOUR REQUEST. A RESPONSE WILL BE PROVIDED WITHIN 10 BUSINESS DAYS OF RECEIPT.