Classroom Visit Form http://www.cabq.gov/artsculture/biopark/camps-classes/teachers/classroom-visit-form http://www.cabq.gov/@@site-logo/seal-small.png Classroom Visit Form Contact Information Name of Primary Contact Name of School or Group Address City Telephone Number Email Address Classroom Visit Information Number of Students Number of Adults Grade Level of Students Program requested by Age PreK-2 Saving our Bosque Grades 3-5 How do I grow? Grades 3-5 Web of Life Grades 6-8 Survival Specialist Grades 6-8 Reproduction of the Fittest Grades 9-12 Group Survival Special Request, please specify below If you selected Special Request on the question above, please specify below. Provide Three (3) Date Options Program Start Time Number of presentations requested Program End Time Location Within 25 miles of Albuquerque City Center 25 – 50 miles from Albuquerque City Center 50 – 100 miles from Albuquerque City Center Over 100 miles from Albuquerque City Center Are others at your school also interested in a program? Yes No Unsure Additonal Comments Method of Payment Need PO Credit Card Check Will financial assistance be needed? If financial assistance is needed, please answer all of the questions in the section below. Yes No Financial Assistance Questions If you answered yes to the question above, please complete all of the questions below. What County? What School District? List your organization's participation in public or private assistance programs and/or provide us with an understanding of your financial need. Examples include Free and Reduced Lunch, Medicare/Medicaid, Aid to Families with Dependent Children. Why do you want your class to participate in the Discover the BioPark Program? How will this field trip or classroom visit connect to your classroom lessons?
