Request Form

Please use this form to request programs and/or resources. This does not guarantee a reservation. Confirmation will be sent by e-mail.

School Information

School Name:		County:
Group Contact:		School Phone:
E-mail:		Alternate Phone:
School Address (street, city, zip):		Fax:

Program Request

I would like to request the following program:

Guided Tour

Title:

Grade (s):

Special needs (ESL, bilingual, learning disabilities):

Number of Chaperons:

Please provide information about students’ area of study and purpose of visit to aid in tour guide preparation.

Number of Students:

Request specific galleries

If yes, please specify.

Date/Time (First Choice)	Date/Time (Second Choice)	Date/Time (Third Choice)

Self-Guided Tour
Galleries:
Grade (s):		Special needs (ESL, bilingual, learning disabilities):
Number of Chaperons:		Please provide information about students’ area of study and purpose of visit to aid in tour guide preparation.
Number of Students:		Request special gallery areas? If yes, please specify.

Teacher Workshop

Workshop Title:
Workshop Date:
Teacher Name :
Subject Specialty:
Grade Level(s):
Preferred Email:
	Fee information: Payment is required to confirm workshop registration. Further information will be included in the email response to your submission.

Resource Request

Number of Students Served:
I would like to request the following resource:
Format	Title (Include grade; please check the listings to ensure appropriate format; not all resources are available in all formats.)	Date (First Choice)	Date (Second Choice)
video
discover kit
slide kit
transparency kit
CD-ROM
color prints
traveling exhibition