STEM with DCM Reservation Request for Groups

School/Organization/Group Information

School/Organization/Group Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Information

Contact Person*

First Last

Contact Person Title

Contact Phone*

Contact Email**

Request Information

Grade Level**

Number of Students**

Choose A STEM with DCM Lab**

Create A Creature

Sound All Around

GeoSpace

Build A Bridge

Requested Date (1st Choice)**

Requested Date (2nd Choice)**

Requested Start Time*

Chosen Format**

Virtual

In-Person at DCM

In-Person in Your Classroom

Would you like to include a Field Trip with your lab? (For In-person at DCM Only)

Yes

No

Technology - For Virtual Format Only

What video conferencing platform do you use? (Zoom, Seesaw, Google Meet or something else)

Additional Questions/Requests

Do you have any additional questions or requests?

STEM with DCM Reservation Request for Groups