External Environmental Education Program Request
What is the school/organization name?
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Name
*
First Name
Last Name
Address of school/organization
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Office Phone Number
*
-
Area Code
Phone Number
Work Cell Number
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Area Code
Phone Number
We require a minimum of 4 weeks advanced notice for all programs that do not involve the ECO Bus. We require a minimum of 6 weeks notice for all ECO Bus program requests.
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My request is for a non ECO Bus program and is more than/equal to 4 weeks away
My request is for an ECO Bus program and is more than/equal to 6 weeks away
My program request is for less than the minimum required advanced notice but I would still like to discuss my options with program staff.
Does this event have a specific date or are you flexible?
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Please Select
Specific Date
Flexible
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Answer questions 1-11 if your request is for a program/event on a specific date and time.
1. What is the specific date of the program?
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Month
-
Day
Year
Date
2. Time Program Begins
Hour Minutes
AM
PM
AM/PM Option
3. Time Program Ends
Hour Minutes
AM
PM
AM/PM Option
4. Who is the contact person for this event?
5. What is their phone number?
Please enter a valid phone number.
Format: (000) 000-0000.
6. Program/Event Name
7. Program/Event Description
8. Address location of program if different from the address of the school/organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
9. Ages of participants
0-4
5-12
13-17
18+
55+
All Ages
10. How many people do you anticipate attending this event/program?
11. What are you interested in having us do for this event/program?
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If you have an idea of a program you would like to have us to do for you and you are flexible on dates and times please answer questions 12-17 below.
12. Are you interested in a outreach program or a field trip?
Outreach: We come to you
Field Trip: You come to us
13. If you selected OUTREACH please put the address of the location you would like for us to present at
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
14. What are you interested in having us do for you?
15. Do you have any dates and times in mind? If so please list them below.
We will do our best to accommodate these dates but if no availability exists we will discuss other potential dates with you.
16. Would you like a phone call to discuss any questions?
Please Select
Yes
No
Unsure at this time
We will still be in correspondece through email but if you prefer to set up a time to talk we can make that happen.
17. If you selected YES to a phone call please let us know what days of the week and times are most convenient for us to give you a call.
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Payment amount owed for the program will be discussed with you after the Education team reviews your request.
Payment for programs is not due until after the service has been rendered. An invoice will be sent no later than 48 hours after the program. Please indicate below how your organization would like to pay for the program.
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We would like to mail a check
We would like to call and pay with a card over the phone
We would like to pay online with a card
Unsure at this time
A member of the Environmental Education team will be in touch no later than 2 business days after the request has been submitted. Please understand that submission of this form does not guarantee that we will be able to meet your request. Every effort will be made to accommodate your needs and alternate dates or plans will be presented if available.
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