Contact information Instructor name * Street address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP * Office phone * Email address * Mobile phone * School and course information School * Grade level * Subject (if applicable) * Number of students * Number of Teachers and Chaperons * Visit information Preferred date of visit * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20162017201820192020 Arrival time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Departure time * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Are you requesting a presentation by a museum staff member? * yes no staff and topic information If 'yes', enter the name or position of a staff member (if known), or a description of the material you would like presented by a museum staff member. Visit plan * Describe the assignment your students will be working on, the specific activities or tasks they will be completing, and the areas of the museum they will primarily use. Include an agenda for your visit and any assignment materials you plan to use with your students, as applicable. AttachmentsAttach up to three documents below. Acceptable formats: png, gif, jpg, txt, doc, docx, odf, pdf, xls, xlsx, zip document 1 Files must be less than 800 bytes.Allowed file types: gif jpg png txt odf pdf doc docx xls xlsx zip. document 2 Files must be less than 800 bytes.Allowed file types: gif jpg png txt odf pdf doc docx xls xlsx zip. document 3 Files must be less than 800 bytes.Allowed file types: gif jpg png txt odf pdf doc docx xls xlsx zip.