Virtual Program Request (Educator)

Virtual School Program Request Form
School Name*
Main Contact*
Phone Number*
School Email Address*
Total Number of Students Participating*
Number of Teachers/Classrooms*
Number of Classroom Learners*
Number of Remote Learners*
Grade Level*
Program Requested*
Program Date Requested*

MonthDayYear
Subject to availability. Request must be made at least two weeks in advance.
Program Time Requested (ET Eastern Time Zone)*

Subject to availability. Program start time can be between 10:00 a.m.-4:00 p.m. ET.

AM/PM Option

Please complete the information below for our records. Payment will be required prior to participating in the program. Member schools and IPS schools will not be billed.
School District/Corp.*
County*
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Billing Phone Number
Discount Code
Mailing Address (if different from billing address)

Street Address

Street Address Line 2

CityState

Zip Code
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Questions or comments
You can also contact schoolprogams@childrensmuseum.org with questions.
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Virtual School Program Request Form