Virtual Program Request

Today's Date:*

School/Organization Name: *

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

County:

School District*

School's FRL %

SOLE partner school?

CDPW Funded Program

Primary Contact Name: *

First NameLast Name

Primary Contact Email: *

All communication will be sent to this address

Phone Number: *

Additional Teacher #1 Email: (optional)

(optional)

Additional Teacher #2 Email : (optional)

(optional)

Which of the following programs would you like to reserve?

Dinosaur Freeways Virtual ProgramADD ON: 30-min Live Q&A with a Dinosaur Ridge ScientistADD ON: Immersive 360-Degree Virtual Tour ($10 per group)

Which of the following programs would you like to reserve?

Dinosaur Ridge Geology and Paleontology CurriculumAsk a Geologist or PaleontologistVirtual Tour of Dinosaur Ridge

If you selected Ask a Geologist or Paleontologist, which of the following two options do you want to use?

15-minute pre-recorded version received as a weblink to share with your students/participants any time30-minute live session that will be scheduled as an interactive, one-time experience

If you selected Ask a Geologist or Paleontologist, which of the following options do you want to use?

15-minute pre-recorded version received as a weblink to share with your students/participants any time30-minute live session that will be scheduled as an interactive, one-time experience1 hour live session that will be scheduled as an interactive, one-time experience

I will stream the live session from a shared space where my students/participants will all be assembled to watch on one screen togetherMy students/participants will stream the experience from multiple devices at once

Curriculum Focus or Area of Interest:*

Ex: Dinosaurs, Earth Systems, Life Science, Physical Science, Geology, Paleontology etc.

Student Grade(s):*

(NA if not applicable)

# Students/ Participants:*

# Teachers Participating*

Preferred Dinosaur Freeways Virtual Program Start Date:*

Only if you selected the ADD ON: 30-min Live Q&A with a Dinosaur Ridge Scientist, select the following:

Live session for 1 classroom (up to 35 students)Live sessions for 2 or more classrooms (discount available, please let us know the number of classrooms in the comments)

The live session will be streamed from one screen in the classroom.The live session will be streamed on individual devices.

Yes, Dinosaur Ridge has permission to record the online session (volunteer and staff training only).No, Dinosaur Ridge does not have permission to record the online session.

Preferred date and time for the ADD ON: 30-min Live Q&A with a Dinosaur Ridge Scientist:

10am11:30am1pmOther

How did you learn about our virtual program?

Comments/Questions:

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Note: After submitting your form you will receive an auto-confirmation from our system. Your form will be reviewed by our staff and you will be sent an email with payment due and payment link (for non-scholarship schools), followed by login instructions to our virtual portal. Thank You!

Virtual Program Request Form