PacSci Virtual Field Trip Inquiry
Primary contact first name:
Primary contact l
ast name:
Primary contact e
mail:
Primary contact position:
Primary contact phone number:
We will not use your phone number for solicitation purposes and will only be used in case of emergencies pertaining to your Virtual Field Trip.
Organization type:
Please select...
Community Organization
Day Care
Private Group/Family Event
Nonprofit Organization
Library
School – Public
School – Private
University
Homeschool
Private Company
Other
Please specify name of organization/school:
Organization/School street address:
City:
State:
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Country of residence:
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
Czech Republic
Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa
San Marino
São Tomé and Prìncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Viet Nam
Virgin Islands ( British )
Virgin Islands
Wallis and Futuna
Yemen
Zambia
Zimbabwe
ZIP/Postal Code:
Anticipated number of participants:
Age range of participants (select all that apply):
PreK
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6 - 8th Grades
9 - 12th Grades
Other
Please specify:
Program title(s) you are Interested in (select all that apply):
Animal Adventure (PreK-2nd)
Ecosystem Investigators (3rd-8th)
Featured Creatures (3rd-8th)
Forces of Energy (3rd–8th)
Global Soundscapes (K-8th)
Piece of Mind (3rd-8th)
Radical Reactions (K-8th)
Robots on Mars! (3rd-8th)
Stick the Landing: Engineering Series (3rd-8th)
Virtual Planetarium: Night Sky Tonight (PreK-12th)
Virtual Planetarium: Planetary Geology (K-12th)
Wetland Wonderers (PreK-2nd)
Unsure
Please note: Radical Reactions, Global Soundscapes, and our Virtual Planetarium programs are suitable for large audiences. All other PacSci Virtual Field Trip titles have a maximum attendance of 50 participants.
Would you like to schedule more than one program?
Yes
No
Do you have a specific date in mind for your Virtual Field Trip?
Yes, I have a specific date in mind.
No, I do not have a date in mind.
Please select the date you have in mind for your Virtual Field Trip:
Please select your preferred days that work for you. We will contact you with specific dates that best match your preferences:
Preferred day(s) of the week:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Unsure/No preference
Is there a specific time of day you prefer for your Virtual Field Trip?
Yes, I have specific time(s) in mind for my session.
No, I have no preference of time for my session.
Please specify the time you prefer
:
Add another preferred time
Add another time preference
Please specify the time you prefer
:
Add another preferred time
Add another time preference
Please specify the time you prefer
:
Has your school or organization participated in a PacSci Virtual Field Trip before?
Yes
No
Where did you hear about PacSci Virtual Field Trips?
Please select...
Internet search
Social media
PacSci email
Word of mouth
PacSci staff reached out to us
Other
Please specify:
If you have a promo code, please include:
Does your school, organization or community group primarily serve low-income or Title I audiences?
We are a Title I School.
We are a community group that serves low-income or Title I audiences.
I am unsure
No, we do not.
What learning model do you anticipate your group will be in on the date of your program?
Please select...
All in-person
All remote
Hybrid (some remote and some in-person participants)
Not sure
Please supply any additional comments, information, requirements, or questions you have about Virtual Field Trips with PacSci here:
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