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Classroom Outreach Program Request Form
Visit the main University of Oregon site
Classroom Outreach Program Request Form
School Info
SCHOOL INFORMATION
Please complete the fields below.
School/Organization
This field is required.
School District
This field is required.
Teacher/Leader
This field is required.
Email
This field is required.
Phone
This field is required.
Address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
County
SCHEDULING
We are happy to schedule two days of programming at your site; simply complete both the
Day One
and
Day Two
sections below. Want to schedule more than two days? Let us know in the Additional Information field below. We can discuss any needed adjustments to your program times when we confirm the dates.
Day One
First choice date
This field is required.
Second choice date
This field is required.
Group 1: # of Students
This field is required.
Grade
This field is required.
Time
This field is required.
Program
This field is required.
- Select -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Ancient Animals of Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 2: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Ancient Animals of Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 3: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 4: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Day Two
First choice date
Second choice date
Group 1: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 2: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 3: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Group 4: # of Students
Grade
Time
Program
- None -
Oregon's First Engineers (Grades 1-2
Exploring Fossils (Grades 1-3)
Animals of Ancient Oregon (Grades 2-5)
Investigating Artifacts (Grades 2-5)
Adventures in Archaeology (Grades 6-8)
Rocks on the Road (Grades 3-5)
Additional Information
Are you located within a 90-minute drive from the museum?
Yes
No
Do any students have special needs of which the outreach educator should be aware?
Additional Information
The museum offers a 50 percent discount on program fees for any school with 50 percent or more of its students eligible for free or reduced lunch. Does your school qualify for this discount?
Yes
No
