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?

First Name

Last name

Phone

Who Do You Represent

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

mm/dd/yyyy

Visit Request Date 2nd Choice

mm/dd/yyyy

Estimated arrival time

Estimated departure time

Number of groups and/or class periods

Age range of students

Number of students per group

Does your school qualify for Title 1?

% Free/Reduced Lunch

% American Indian

% Minority

Grade Level Choice

Choose a category of lessons based on age groupings.

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.

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