Science Engagement's Workshop Program 2023-2024

Enter your information below to request a day of STEM or Digital Literacy workshops.

Please submit a separate entry for each day you would like us to visit your organization.

Page 1 of 3 - Organization Information

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Organization Contact's Name Organization Contact's Name First Last
Booking Contact Phone Booking Contact Phone - ### - ### ####
Booking Contact Email

Confirm Email Address
ORGANIZATION INFORMATION

Tell us more about your organization to better assist us in sending you a recommended schedule.
Name of School/Organization
Our organization provides services to:

Our organization provides services to: Co-ed Youth Black Youth All-Girl or Gender Diverse Youth
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Start of Day Time Start of Day Time : HH MM AM/PM
End of Day Time End of Day Time : HH MM AM/PM
When are your lunch break(s)?
When are your recess break(s)?
PREFERRED DATE OPTIONS

List three dates that your organization is available. If you would like us to visit you more than once, please submit multiple booking forms.

Other weekdays are subject to availability.
Date Option 1 Date Option 1 / MM / DD YYYY
Date Option 2 Date Option 2 / MM / DD YYYY
Date Option 3 Date Option 3 / MM / DD YYYY
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Science Engagement's Workshop Program 2023-2024

Science Engagement's Workshop Program 2023-2024

Page 1 of 3 - Organization Information

ORGANIZATION INFORMATION

PREFERRED DATE OPTIONS