Outreach Program Request Form

Email

This field is for validation purposes and should be left unchanged.

Main Contact Information

Full Name*

Prefix First Last Suffix

Job Title / Position*

School/Organization Contact Phone Number*

Alternate Contact Phone Number*

Email*

Will you be in attendance during the outreach program?*

Yes, I will be in attendance.

No, I will not be in attendance.

If you will not be in attendance during the outreach program, please provide contact information of the individual who will be the lead contact at the program.

Name*

Prefix First Last Suffix

Job Title / Position*

School/Organization Contact Phone Number*

Alternate Contact Phone Number*

Email*

Confirmation materials and invoices will be provided via email. When we send those materials, we can copy other individuals in the emails as well. If you would like other individuals included, please select the contact type below and then list the email address(es).*

N/A

Bookkeeper/Accountant

Secretary/Administrative Assistant

Principal/Administrator

Other Contact(s)

Bookkeeper/Accountant Email*

Secretary/Administrative Assistant Email*

Principal/Administrator Email*

Other Contact Email(s)*

School/Organization Information

School/Organization Name*

School/Organization Address*

Street Address City State ZIP Code

School/Organization Affiliation*

Elementary School

Middle School

K-8 School

High School

Afterschool Provider

Community Organization

Youth-Serving Organization

Other

Preferred Schedule

How many program sessions are you looking to book?*

Please note: We can only present a maximum of 3 classroom programs per visit with a 15-minute clean and reset between each program session. We do not bring multiple topics on a visit.

Session #1 Preferred Start*

Programs cannot start before 8:00 AM

:

Session #1 Preferred End*

:

Session #2 Preferred Start*

:

Session #2 Preferred End*

:

Session #3 Preferred Start*

:

Session #3 Preferred End*

:

Qualifying K5-12 grade Wisconsin schools that have a 70% or greater economically disadvantaged status (as determined by the Wisconsin Department of Public Instruction) are eligible for reduced program costs. Would you like to apply for reduced program costs?*

Visit https://apps2.dpi.wi.gov/reportcards and use the most recent School Report Card information from DPI. Within your Report Card, find the circle graph and % under the Economically Disadvantaged heading.

Yes, my school qualifies

No, my school does not qualify

N/A, request not for a school

Additional Notes

Please list any additional notes, requests, program preferences, and/or any other special information we should know.

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Outreach Program Request Form

Main Contact Information

School/Organization Information

Program Information

Preferred Program Date

Preferred Schedule

Additional Notes

ADDRESS

Phone

Spring & Summer Hours 2026