STEM on the Road · Class Request Form

Offered in December, January, and February

Each 45-minute STEM on the Road class is led by our certified instructors and environmental educators as they guide your students through hands-on, engaging activities that extend the Garden into your classroom, in alignment with Alabama Science Standards.

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Contact Information

Name *

First

Last

Your Title *

• Lead Teacher
• Administrator
• Parent
• Other

Email *

School Information

School Phone Number *

Class Date would

School Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Are you a Title 1 School? *

• Yes
• No

Number of classes *

Number of students per class *

Would it be possible to combine classes for a single presentation? *

• Yes
• No

STEM on the Road Class Information/Options

Select Class Program *Vermiculture [Grades K-3rd]Microscopes [Grades K-3rd]Bird Beaks [Grades K-3rd]Watersheds [Grades 4th-6th]Soil Exploration [Grades 4th-6th]Water Testing [Grades 4th-6th] (Must have access to natural water on school property.)Middle School Special/Custom ClassHigh School Special/Custom Class

Our staff will need the following to host this program: indoor OR outdoor classroom space with...

1. Seating for students at tables or on the ground
2. Easy access to a sink
3. A table to hold our program materials.

Can you provide these? (See note above) *

• Yes
• No

Do you have access to natural water on school property? *

• Yes
• No

How much time would be available for us to set up program materials? *

Desired Outreach Class Date (First Choice) *

Desired Program Start Time *

Please note the desired start time for the program based on your 'First Choice' desired outreach class date.

Desired Outreach Class Date (Second Choice) *

Desired Program Start Time *

Please note the desired start time for the program based on your 'Second Choice' desired outreach class date.

Desired Outreach Class Date (Third Choice) *

Desired Program Start Time *

Please note the desired start time for the program based on your 'Third Choice' desired outreach class date.

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