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School/Organization/Group Information
School/Organization/Group Name
*
Address
*
Street Address
Address Line 2
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Contact Person
*
First
Last
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*
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*
Request Information
Grade Level*
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Number of Students*
*
Number of Educators*
*
Number of Adults (not educators)*
*
Choose A STEM with DCM Lab*
*
Sound All Around
Wings & Things
Build A Bridge
Create A Creature
The Art of Shapes
Mystery of the Suspicious Substance
Nature's Adventure
Requested Date (1st Choice)*
*
MM slash DD slash YYYY
Requested Date (2nd Choice)*
*
MM slash DD slash YYYY
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)
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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?
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