PacSci Virtual Field Trip Inquiry

Primary contact first name:

Primary contact last name:

Primary contact email:

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 specify name of organization/school:

Organization/School street address:

City:

State:

Country of residence:

ZIP/Postal Code:

Anticipated number of participants:

Please select the date you have in mind for your Virtual Field Trip:

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 :

Where did you hear about PacSci Virtual Field Trips?

Please specify:

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 unsureNo, we do not.

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