PLC Request Form_Experiences

Thank you for your interest in Poudre Learning Center (PLC) programming! If you would like to schedule an educational program for your classroom or organization, please complete this form. A lead contact is required for communication purposes. Our team will review your request and contact you to confirm the scheduling details.

Please visit PLC.greeleyschools.org/educators for more information
Contact Information
Lead Contact Name*
Email*
Phone Number*
Please enter a valid phone number.
If more than one educator is involved, please list their name(s) and email(s):
School or Organization Name*
Check this box if you are a public school within Greeley-Evans School District 6.
School or Organization Address*

Street Address

CityState / Province

Postal / Zip Code
Name of school Office Manager or Administrative Assistant

First NameLast Name
Office Manager email
example@example.com
Office Manager phone
Please enter a valid phone number.
Participant Information
Total number of students*
NOTE: If applicable, this number will be used to calculate billing totals, regardless of actual attendance.
Number of classes*
Grade level or age range*
Enter class subject if HS
How many students with disabilities will be present?*
Ex. Mobility differences, neurodivergence, etc.
Please state ways we can accommodate your students to support their experience. The more information provided, the better we can differentiate our programming to serve them!*
How many CLD students will be present?*
Will you have an interpreter for your CLD student(s)?*

YesNoOther
Please list which languages are represented by your CLD students, if any.
Program Request

Tuesday - Friday only. Please select a date no sooner than 2 weeks from today to allow for proper planning and resource availability. For program information please visit: PLC.greeleyschools.org/educators
Are your students participating in Impact Earth or Caring for Our Watersheds?*

YesNoNo, but I'd like more information
Location Request*

School ClassroomPoudre Learning CenterOther
First Choice*

MonthDayYear
Date
Second Choice*

MonthDayYear
Date
Arrival Time*

Hour Minutes

AM/PM Option
Departure Time*

Hour Minutes

AM/PM Option
Additional Scheduling Comments:
Click here to view the Information Guide with lesson descriptions.
After viewing the Information Guide, please list lessons you would like included in the program. NOTE: A half-day program can do 1-2 lessons, a full day can do 3-4. *
Does each classroom have access to a working sink?*

YesNoOther
Will our team have access to a classroom projector?*

YesNoOther
What do you hope to achieve by the end of the experience?*
Have you completed our scholarship form? It covers program fees & transportation.*
Scholarship Form: https://form.jotform.com/242337141270144
How did you recently hear about the Poudre Learning Center?

ReferralSocial MediaSearch Engine (Google, Bing, etc.)Previous PLC programEmailOther
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Contact Information

Participant Information

Program Request