STARBASE Edwards Interest Form

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Please fill out this form if your school, or district, is interested in attending STARBASE's program. We have limited spots for schools and so filling out this form reserves you a spot on our waitlist and gets you in direct contact with us. Please note: STARBASE needs two points of contact (POCs) to complete this form; one of which needs to be at either a school or district leadership level.

District Name (No Abbreviations please): *

School Names (No Abbreviations please): *

Number of Classes: *

Each school needs to provide the number of 5th grade classes (or 5/6th combos) they would like to attend. Each 5th grade class represents one spot at STARBASE, so it is important for us to have exact numbers when scheduling.

School Addresses: *

Desired Quarter For STARBASE Attendance (Check Multiple Options If You Have Scheduling Flexibility): *

Quarter 1 (August to January)

Quarter 2 (Mid January to March)

Quarter 3 (Mid March to June)

Quarter 4 (Summer 2024)

Required

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