Tech Experience Tours - Application Form Please provide the following information to allow us to make the best match possible between educators and participating companies. Are you from an educational institution or STEM company/business?*Educational Institution/Non-profit OrganizationCompany/BusinessEducational Institution/Non-profit OrganizationTeacher Name* First Last School Name*School Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Daytime Phone*Grade level involved in field trip:* Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Other*Number of Students Attending*First date for a field trip* Date Format: MM slash DD slash YYYY Final date to schedule a field trip* Date Format: MM slash DD slash YYYY Topic of interest for the field trip* Computing, Information, & Programming Engineering & Manufacturing Agricultural & Food Health Sciences & Medical Device Energy Efficiency & Sustainability Other Other*If you selected a topic(s) above, please provide more background concerning your choice*Company/BusinessMain Contact Name* First Last Organization Name*Organization Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Daytime PhoneSecondary Contact Name* First Last Secondary Contact Email* First date for a field trip* Date Format: MM slash DD slash YYYY Final date to schedule a field trip* Date Format: MM slash DD slash YYYY Preferred grade levels for field trip* Middle School (Ages 12-14) High School (Ages 14-19) Any Number of students you could host in one tour*Please indicate if there is any other information you would like to share about hosting preferences.*CAPTCHA
