Virtual Program Request

Virtual Program Request Form

Remote Learning at Dinosaur Ridge
Today's Date:

MonthDayYear
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:
Format: (000) 000-0000.
Additional Teacher #1 Email: (optional)
(optional)
Additional Teacher #2 Email : (optional)
(optional)
Which of the following programs would you like to reserve?
Which of the following programs would you like to reserve?
If you selected Ask a Geologist or Paleontologist, which of the following two options do you want to use?
If you selected Ask a Geologist or Paleontologist, which of the following options do you want to use?
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:

MonthDayYear
Only if you selected the ADD ON: 30-min Live Q&A with a Dinosaur Ridge Scientist, select the following:
Preferred date and time for the ADD ON: 30-min Live Q&A with a Dinosaur Ridge Scientist:

MonthDayYear
Other
How did you learn about our virtual program?
Comments/Questions:
.
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!
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Virtual Program Request Form