Let's Talk Science Visit Request Form 2023-24

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Thank you so much for your interest in Let's Talk Science! Please fill out ALL SECTIONS of the google form below so that we have all the information we need to accommodate your class. PLEASE NOTE that we do require AT LEAST two-weeks notice so we can properly organize with our volunteers and source materials.

Email *

Additional Email(s) of Educator(s) participating in the session if different from above (please list all):

Phone Number(s) of Main Educator(s) for Contact *

Full Name(s): *

School/Organization: *

School/Organization Address: *

Grade/Age Group: (select all that apply) *

Pre-School (3-5 years old)

Kindergarten (5-6 years old)

Grade 1 (6-7 years old)

Grade 2 (7-8 years old)

Grade 3 (8-9 years old)

Grade 4 (9-10 years old)

Grade 5 (10-11 years old)

Grade 6 (11-12 years old)

Grade 7 (12-13 years old)

Grade 8 (13-14 years old)

Grade 9 (14-15 years old)

Grade 10 (15-16 years old)

Grade 11 (16-17 years old)

Grade 12 (17-18 years old)

Required

Number of sessions:
***If you are requesting more than 5 sessions, these requests may be difficult to fulfill. Please arrange a phone call with us to discuss options*** *

One

Two

Three

Four

Five

More than 5

Number of participants per session: *

Please indicate the workshop(s) of interest. Refer to our Activity Offerings here: https://drive.google.com/file/d/1huT2OBgvLuIwGCTpxKWPfZ0LjfR9kQ6M/view?usp=sharing *

Please list your SPECIFIC top three preferred dates for a visit from our volunteers. *

What time would the visit(s) occur? ***If there are multiple sessions/periods please indicate the EXACT start/finish time of each period*** *

If you have any special / accessibility requests or notes, please list them here, we are happy to accommodate and help in anyway we can! *

We have returned to in-person visits, however, if necessary we can proceed in a virtual format. Which format would you prefer? *

Virtual

In-person

Is there any additional information you'd like to share with us?

Date completed: *

YYYY

Thanks so much for filling out this request form! If your request falls within the next 30 days we will get back to you ASAP. Due to high request volumes, if you are requesting for later in the year we will contact you about a month out regarding your visit(s).

Cheers,

Katrina and Your Memorial University Let's Talk Science outreach team

Email: lts@mun.ca OR ltslocal@mun.ca
Phone: (709) 864 - 4028

A copy of your responses will be emailed to the address you provided.

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