PROMISE Team Visit Form

PROMISE Team Visit Form

The PROMISE team is available to visit classrooms with a hands-on activity that teaches learners about biomedical research. Please fill out this form if you would like a visit from the PROMISE team. If you would prefer to bring learners to the PROMISE community lab, please fill out this form instead.

We have activities for students in grades 1-12 and adult learners. Please review the offerings for this year to decide on a lesson. The team is available to travel but will consider each request on a case-by-case basis. Please request a date at least 3 weeks out from the event date. Someone on the PROMISE team will contact you within 3 days of your request.

Are you requesting a virtual or in-person visit?*

Select or enter value

First Name*

Last name*

Email*

Phone*

Who Do You Represent*

Select or enter value

Which organization do you represent?

Select a District

Select or enter value

Please write in your district

District Name

Please include district name and number i.e. Lennox 41-4

Name of School*

School Address*

Address Line 1

Address Line 2

City

State

Zip Code

Job Title*

Visit Request Date 1 Choice*

Visit Request Date 2nd Choice*

Estimated arrival time*

Estimated departure time*

Number of groups and/or class periods*

Select or enter value

Age range of students*

Select or enter value

Number of students per group*

Does your school qualify for Title 1?*

Select or enter value

% Free/Reduced Lunch*

% American Indian*

% Minority*

Grade Level Choice*

Choose a category of lessons based on age groupings.

Select or enter value

Lesson or topic *

Please view the lesson offerings linked above.

Schedule

If needed, please record the schedule that the PROMISE team will be following. i.e. scheduled class time, break time, time for lunch.

How did you hear about us?*

Select or enter value

Send me a copy of my responses

Privacy Notice|Report Abuse