Apply for a STEM Field Trip STEM Questionnaire Name(Required) First Last Email Address(Required)Name of School or Business(Required)Please enter your complete Street Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please put the office number for your school(Required)Please list your cell phone number so we can reach you on the day of your field trip(Required)Please select the option which best describes you(Required)-Select-AdministratorTeacherParentWhat best describes your group? Please choose one(Required)-Select-PublicPrivatePublic Title OneCharterMontessoriHomeschoolOtherPlease provide your non-profit certification number(Required)What grade level(s) will be participating in the field trip?(Required)You may combine tiered grade levels, we suggest a minimum of 50 students and maximum of 125.Do you want an in person field trip or virtual experience?(Required)If choosing in person, please choose your lesson plan on the next question.SelectAt the Skating FacilityVirtual Experience - Lesson Stem in SportsWhat lesson plan are you interested in our educator teaching?(Required)- Select -The Science of RollerFormulas, Fraction and FunMotion & Skate DesignNewton's Law of MotionMusic, Math & Roller SkatingThe Science Behind Roller and Ice HockeySuper Sound! Acoustics & Rink DesignArcade STEMScience of LightingHeart, Health and FitnessVirtual Only - Football, Soccer, Roller Skating and Roller DerbyWhat date would you prefer for your event? Please list at least 3 available dates for your field trip. We will do our best to accommodate you.(Required)How many students are you planning on bringing?(Required)How did you hear about our S.T.E.M program at Skate World?(Required)What three hour time period would you prefer for your event? Typically because of bus transportation, the earliest arrival is 9:30am. If you can only do 2-2.5 hours, we can adjust our schedule to accommodate your needs. For example, please type 9:30am-12:30pm or 9:45am-12:15pm(Required)Would you be interested in having pizza and drinks for lunch after the STEM lesson? We have an amazing deal with fresh pizza for our school groups! 1 slice/1 drink =$4 OR Unlimited pizza and drinks $7 per student. $7 Unlimited pizza / drinks $4 One slice / one drink No FoodPlease give us the email address for the person handling accounts payable at your school.(Required) Any Additional Comments?CAPTCHACommentsThis field is for validation purposes and should be left unchanged.Δ
