STEMM Delivered Visit Request
Come take a ride on the STEMM Delivered Bus! Temple University’s College of Science and Technology proudly operates STEMM Delivered assisting schools and teachers by engaging students in science, technology, engineering, math and medicine on our mobile science lab! Please let us know how we can work with you by completing the request below. This form should be filled out for each date request separately.
Requestor Contact Information
Requestor Name
*
First Name
Last Name
Requestor Email
*
example@example.com
Requestor Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requestor Affiliation to School/Organization (e.g. Teacher, Admin, Director, Principal, Staff)
*
School/Organization Information
Name of School/Organization
*
School/Organization Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Principal/Director Name
*
First Name
Last Name
Prinicipal/Director Email
*
example@example.com
Principal/Director Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your school/organization's Principal/Director know about and approve this request for a visit?
*
Visit Details - Curriculum & Logistics
Requested Date of Visit
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Backup Requested Date of Visit
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Arrival Time
*
Hour Minutes
AM
PM
AM/PM Option
Requested Departure Time
*
Hour Minutes
AM
PM
AM/PM Option
Grade Level
*
Can you tell us the approximate number of students to expect and if they are already divided into groups? If so, what is that breakdown?
*
Requested Curriculum Topic
*
Requested Curriculum Support and/or Materials
*
Are you requesting any additional curriculum support prior to or following the visit? If so, please provide as much detail as you can in order for us to help.
*
Please explain in detail where you anticipate the STEMM Delivered bus can park for the visit? Make sure to include any details about possible obstacles to entering or exiting.
*
Does your school/organization have insurance that allows for the STEMM Delivered bus to park on school property and allow students/staff/faculty to visit the bus?
*
Does your school/organization require any specific information or documents in order for us to the visit? If so, please explain.
*
Submit
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