REQUEST HANDS ON SCIENCE

REQUEST HANDS ON SCIENCE

You need to be a principal, teacher or authorized PTA representative to make a request. Please email JNewman@DiscoveryCtr.org if you are interested but are not a Principal, PTA representative or teacher at the school.
Please read before filling out this form. Page 2 is FAQs for parents
Person Requesting The Event*

PTA representativePrincipalScience Teacher
Program is designed for grades K-5
If your school does not appear, please email JNewman@DiscoveryCtr.org
School is in

Putnam CountyDutchess CountyLower Westchester (south of White Plains)Upper Westchester (north of White Plains)
We prefer

WeeknightSaturday
Choose a town in Dutchess we serve
If you do not see your town email JNewman@DiscoveryCtr.org
Choose a town in Upper Westchester we serve
If you do not see your town email JNewman@DiscoveryCtr.org
Choose a town in Lower Westchester including White Plains
If you do not see your town email JNewman@DiscoveryCtr.org
Name*

First NameLast Name
Your Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Please select phone type*

Cell phone we can textHome landlineSchool landline
Extension
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred weeknight program (only available in some towns)

MonthDayYear
Date
Back Up Preferred weeknight program (only available in some towns)

MonthDayYear
Date
Preferred Saturday date*

MonthDayYear
Back Up Saturday date*

MonthDayYear
Should be Empty: