Virtual Program Request Form

Salutation- How should we address you to your students? *

Contact First Name *

Contact Last Name *

Contact Phone Number *

Extension

Email Address *

Confirm Email Address *

School Details

School Name

Specify School Name *

School Address 1 *

School Address 2

Town / City *

Province *

Postal Code *

School Phone *

School Fax *

Principal Name

Principal Email

Select Dates and Times

Choose three (3) possible dates for this workshop

Workshop Date 1 *

Workshop Start Time

Workshop Date 2

Workshop Start Time

Workshop Date 3

Workshop Start Time

Choose three (3) possible dates for a technology check. This must occur at least one week before program

Check Date 1 *

Time

Check Date 2

Time

Check Date 3

Time

Does your school have special quarantine requirements for supplies? *

Yes

No

Please explain.

Select Workshops

Please note that there is a maximum capacity of 30 students per workshop.

Workshop

Creature Detective

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Workshop

We’re ‘Wheely’ Moving!

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Workshop

Acoustic Adventure

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Workshop

Earth to Orbit: Climate CubeSats

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Workshop

Earth to Orbit: Mission to Space

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Workshop

Silly Circuits

Grade Relevance

# of Workshops

# of Students

Student's Grade(s)

Additional comments or questions:

CAPTCHA

School Details

Select Dates and Times

Select Workshops

stay in touch

follow us

join our newsletter