Tech Tour Application

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 Organization
- Company/Business
Educational Institution/Non-profit Organization
Teacher Name*
First Last
School Name*
School Mailing Address*
Street Address Address Line 2 City 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*
MM slash DD slash YYYY
Final date to schedule a field trip*
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/Business
Main Contact Name*
First Last
Organization Name*
Organization Mailing Address*
Street Address Address Line 2 City State ZIP Code
Email*
Daytime Phone
Secondary Contact Name*
First Last
Secondary Contact Email*
First date for a field trip*
MM slash DD slash YYYY
Final date to schedule a field trip*
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.*
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