Mobile Museum RegistrationFor School & Community Programs Outreach School & Community Program Registration Form Organization Name * Organization Address * Organization Address Organization Address Organization Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/PostalAddress for Program Location (if different from Organization Address) Address for Program Location (if different from Organization Address) Address for Program Location (if different from Organization Address) Address for Program Location (if different from Organization Address) City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/PostalWould you prefer a Mobile Museum or a Virtual Program? * Mobile Museum (in-person) Virtual (over digital media such as Zoom)IF Virtual – would you prefer we create the zoom link or that you do? * We will make the Zoom link and send link to mmgraw@delmns.org DelMNS will make the Zoom link and attach to contract N/A: I would like an in-person mobile museumContact Name * Contact Name First First Last Last Contact’s Phone Number * Contact’s Email * Program Selection * How to Museum Forces in Motion Dinos, Dinos, Dinos (PreK-5th Grade) Amazing Animal Adaptations (PreK-K) Buggin’ Out (PreK-K) Looking Out My Backdoor (PreK) Pollinator Party (PreK-1st Grade) Motion of the Oceans (K-2nd Grade) Earth’s Place in Space (1st-2nd Grade) How It’s Made (1st-2nd Grade) Trait-astic! (1st-3rd Grade) Animal Adaptations (3-4th Grade) Most Extreme Animals (5-6th Grade) How many classes will we be presenting to? (One program per class, back-to-back) * How many Students/Participants will you have per class? (25 maximum per program) * How many Teachers/Adults will you have per class? * Age Range/Grade of Participants * Phone Number for Day of Contact (if different from Contact Phone Number) Parking Instructions * First Choice Date of Program (Monday-Friday) * Second Choice Date of Program (Monday-Friday) * First Choice Start Time of Program (8:30 a.m.-4:30 p.m.) * 121234567891011 : 0030 AMPMSecond Choice Start Time of Program (8:30 a.m.-4:30 p.m.) * 121234567891011 : 0030 AMPM Do your students/participants have any accessibility needs that we should be aware of? (non-English speaking, non-verbal, mobility needs, special needs, etc.) * We background check all employees and volunteers when they join our team. Does your organization require that DelMNS provide any background checks for our educators? If so, please specify what you require. Any additional concerns or questions? Please let us know here How did you hear about us? Are you interested in financial aid for your programs? select an optionYesNoUnsure If you are interested in financial aid, what percentage of students/participants qualify for Free or Reduced Lunch? (You may be required to provide proof) Submit If you are human, leave this field blank.
