Classroom Visit Request

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At this time, classroom visits are limited to CATALySES teachers.

Email *

Teacher Name *

Teacher Email *

Teacher Cell Phone *

School *

School County *

School Address *

School City *

School Zip Code *

School Phone *

School Fax *

Equipment Lockers

Please choose one or more lockers in the following sections. Note that you may be required to purchase your own reagents. You may only check out lockers that you used during your CPET program. Refer to the list of descriptions on the CPET website.

Equipment

Pipetting Stations

Gel Electrophoresis – E-Gel

Thermal Cycler (**requires pickup or a simultaneous classroom visit)

Heat Blocks

Microtube racks

PCR tube racks

Microcentrifuge (6 place)

Microcentrifuge (12 place)

Vortex

Dissecting microscopes (**requires pickup or a simultaneous classroom visit)

Mosquito Hatcheries (will need for 2-4 weeks, indicate start and end dates in comments)

Other Wet Lab Kits

Pipetting by Design

Activity Kits

From DNA to Protein Structure and Function

Medical Mystery of Epidemic Proportions - Cholera

Stem Cells

Diagnosing Diabetes

Amino Acid Starter Kit

Water Molecules Kit

The Great Clade Race

Curriculum Kits

The Dengue Dilemma Kit

War of the 21st Century: The Cell Cycle, Cancer and Clinical Trials Kit

The Pompe Predicament Kit

Chewing on Change: Exploring the Evolution of Horses in Response to Climate Change Kit

Hands on Human Evolution: A Laboratory Based Approach Kit

Whale Evolution Kit

Books, ID cards, games, movies, etc.

Mosquito ID - ID cards, DVD, bloodsucking pests books

Forest Pathogen ID cards

Contagion Movie

Extraordinary Measures Movie

Classroom book set - Fever: 1793

Classroom book set - The Hot Zone

Classroom book set - The Immortal Life of Henrietta Lacks

Bacterial Pathogens Slide Set

Medopoly

PCR Dash

Giant Microbes (can indicate Set 1, Set 2, or Alimentaries, if desired)

Additional Information

What equipment do you already have in your classroom, related to your selected activity? What reagents will you already have available? *

For example, if you're requesting to do the protein extraction locker, do you have heat blocks? If you're requesting to do the E-Gel locker, are you ordering your own gels?

Grade(s) *

6th-8th grades

9th grade

10th grade

11th grade

12th grade

Required

Subject *

Number of students *

Total number of students in all classes in which you're using the locker.

Number of student groups per class *

Indicate how many sets you would like for the lab. For example, in a class of 24 with 4 students to a group, indicate 6 student groups per class.

Largest class size *

Indicate the largest class you have that will be using the supplies. This is to make sure we include enough for each student, if individual supplies are required for the activity.

Number of classes *

Classes in which you will conduct your activity.

1st Choice Date *

Enter as MM/DD/YYYY

2nd Choice Date *

Enter as MM/DD/YYYY

3rd Choice Date *

Enter as MM/DD/YYYY

Class duration *

Do you wish to borrow equipment for the rest of the week after the CPET visit? *

Yes

Would you like us to come the afternoon before to help set-up the lab and perform a dry run? *

Yes

Other comments or requests

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