WSSC Water Education Outreach Request Form
2022-2023 Academic Year
Thank you for your interest in WSSC Water's Education Programs and Resources. One of our outreach coordinators will contact you to discuss details of your request within 5 business days of receipt of this form.
Questions? Contact Communityoutreach@wsscwater.com
Name of School or Youth Group
County
Group Leader's Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Best time to contact
Number of Participants
Note- if there are more than 25 participants you may have to create smaller groups
Age/Grade Level of Participants
Type of Group
Public School
Private School
College Students
Youth Group/Scouts
Community Group/Adults
Desired Program or Resources
Water Works (3rd-8th grade STEM)
Watershed Defenders (3rd-8th grade watershed E-LIT)
Introduction to Wastewater Treatment (fully virtual, resources provided no in option)
Century of Serving the Community (high school program)
Special Interest Presentation
Click here if you'd like to schedule a classroom presentation
What type of program are you requesting?
Live virtual
In person**
**If requesting an in person program please check your school's policy regarding classroom visitors and note information our staff need to know about COVID precautions/restrictions currently in place at your school (are students able to work in small groups and share materials, masking protocols, are there restrictions our staff on moving between classrooms, etc.).
At this time we can only offer programs on Tuesdays and Thursdays. You will not be able to select any other days of the week. If these days don't work for your group please leave this section blank and share details in the notes.
Preferred Date
-
Month
-
Day
Year
Date
Second Choice Date
-
Month
-
Day
Year
Date
Third Choice Date
-
Month
-
Day
Year
Date
Desired Program Start Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Desired Program End Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Click here to add notes and submit your form
Additional notes and details about your group to help us understand your goal for a WSSC Water program.
I would like to receive future email communication from WSSC Water about education program and community events.
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform