Form: Request for Education and Outreach Services

Form: Request for Education and Outreach Services

Before filling out this form, please prepare a copy of your letter of request addressed to Dr. Joel Joseph S. Marciano Jr., Director General of the Philippine Space Agency. You will need to upload this document during submission of request.

Due to the volume of requests we receive, please allow 5 working days for PhilSA personnel to respond to your request. Kindly also note the following lead times:

Type of Request	Lead Time
Request for Training (for Student, Teacher and other Professionals)	2-3 months from the date of requested training
Request for Resource Speaker (school-wide activity/event)	1 month from date of event
Request for Resource Speaker (classroom-based activity or "Classroom Visit")	2 weeks from date of classroom activity
Research Consultation	1 month from requested date of consultation
Educational Visit/Facility Tour	1 month from date of visit/tour

The personal information being collected may be used for monitoring, sending notifications/updates and other similar activities, in connection to your request. Said information will also be shared within the Philippine Space Agency (PhilSA) for the purpose of informing and/or inviting you to any other events, promotions, proposals, and other activities of PhilSA. Further, said information will be shared within and used by PhilSA for research and monitoring purposes.

I have read and agreed to the above terms.

Requester's Information
Your Name*

First NameMiddle NameLast Name
Your Institution*
Please spell out. Do NOT abbreviate.
Your Position/Designation*
Please spell out. Do NOT abbreviate.
Your email address*

Confirmation EmailPlease enter your email address twice
Contact Number*
Please enter a valid phone number.
Letter of Request (addressed to the Director General)*

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Please select a request:*

Training/Workshop for TeachersTraining/Workshop for StudentsTraining/Workshop for ProfessionalsResource Speaker for school-wide event (career fairs, webinars, symposia, etc.)Resource Speaker (classroom-based activity or “Classroom Visit”)Research ConsultationsEducational Visit/Facility Tour

Details of Request For Training/Workshop
Mode*

VirtualHybridFace-to-face
Area/topic/coverage of training/workshop:*
Expected outcome of the training/workshop:*
Duration of the training/workshop:*
Proposed schedule (time and date/s) of the training/workshop:*
Target Participants of the training/workshop:*
(e.g. Grade 12 Physics Teachers, STEM students, etc.)
Expected number of participants for the training/workshop:*
Other details (Please provide additional information such as brief description of the event, draft program, theme of event, if event is part of a larger activity such as science month, etc..)

Details of Request for Resource Speaker for School-Wide Event
Mode*

VirtualHybridFace-to-face
Area/topic/coverage of talk:*
Duration of talk:*
Name of speaker (if you have a preferred speaker or have already made initial contact to a PhilSA personnel you would like to invite)
Name of school-wide event:*
Description of school-wide event*
Date and time of the school-wide event*
Expected number of participants of the school-wide event*
Other details (draft program, etc..)

Details of Request for Resource Speaker for Classroom Activity
Mode*

VirtualHybridFace-to-face
Area/topic/coverage of information to be shared in the class:*
Date and Time:*
Grade level of students:*
Number of students in the class*
Other details:

Details of Request for Research Consultation
Mode*

VirtualHybridFace-to-face
Title of Research:*
Objective of Research:*
Name(s) of PhilSA personnel you would like to consult/interview (if known):
Questionnaire or List of Questions:*

Cancelof
Other details:

Details of Request for Educational Visit/Facility Tour
Name of Point Person:*
Number of students:*
Number of Accompanying Teachers/Chaperones:*
Date and Time:*
Other Details:

Requester's e-signature

By signing the space below, you are certifying that you are the person completing this form. When you click the submit button, you will receive an email confirmation that your request was received.
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