WREN Classroom Program Request

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Please provide the required information below to request your WREN Classroom Visit. WREN's Program Coordinator will review your request and contact you no later than one week from your submission date. No requests will be accepted if submitted fewer than 2 weeks before the program date.

If you are requesting multiple programs, please fill out one form for each program. For Example: One form for a "What is a Wetland" program, and a separate form requesting a "Pollination" program.

Requesting Teacher's Name *

Requesting Teacher's Email *

Requesting Teacher's Phone Number *

Additional Teachers' Names

School Name and Address *

Classroom Program Requested *

What is a Wetland (recommended for K-5)

Pollination and Host Plants (recommended for grade levels 2-4) *space requirements

Migration Madness (recommended for grade levels 3-6) *space requirements

Our Local Watershed (recommended for grade levels 6-8) *space requirements

Required

Preferred Program Date *

YYYY

Backup Program Date *

YYYY

Preferred Program Time *

Time

Backup Program Time *

Time

Grade Level(s) select all that apply *

Required

Number of classrooms to be visited per day *

Required

Approximate number of students in each class *

Does your school receive Title 1 funding? *

Yes

Are you requesting a reduced program fee as a Title 1 school? *

Yes

Any mobility, behavioral, or other special needs WREN should be aware of? *

What are your main learning objectives that WREN can support with this program? *

Submit

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