E-Week(s) Field Trip Request Form Please enable JavaScript in your browser to complete this form. - Step 1 of 2Name of School *School Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTEA School ID Number *Lead Organizer Name *FirstLastLead Organizer Email *EmailConfirm EmailLead Organizer Phone *Secondary ContactFirstLastSecondary Contact EmailSecondary Contact PhoneNextField Trip DetailsDate choices are limited to the month of February, Wednesday thru Friday only.Preferred date of visit *Alternate date of visit *Arrival Time *Departure Time *Grade Level *3rd4th5th6th7th8th9th10th11th12thTotal Number of Students *Total Number of Chaperones & Additional Adults *Please list how many adults will be attending. If your school is not paying for parents attending, please DO NOT include them in this number so you may receive an accurate invoice.Special Requirements/NotesIn order for the school to receive this program at no-cost, the lead organizer agrees to provide program feedback (e.g. Museum-provided teacher or student surveys) as requested. All program feedback is anonymous. *I agreeSubmit