"*" indicates required fields Name of Institution and/or Group* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name* Contact Phone Number - Cell Number*Contact Phone Number - School Number*Email Address* Total Number of Students* Age Range or Grade Level(s) of Group* Total Number of Chaperones* Names and Emails of Fellow Teachers Attending This Field tripDate Requested - 1st Choice* MM slash DD slash YYYY Date Requested - 2nd Choice* MM slash DD slash YYYY Arrival Time - 1st Choice* Hours : Minutes AM PM AM/PM Arrival Time - 2nd Choice* Hours : Minutes AM PM AM/PM Length of Visit Preferred* 2 -3 hour program (approximate) 4 or more hour program (approximate) ELEMENTARY programs are approximately 2 hours OR 4 hours and topics covered will change based on time. How Do Plants Grow? (Pre-Kindergarten) Apples and Bees (Kindergarten or 1st Grade) Farm to Fork (Kindergarten or 1st Grade) Birds of A Feather (2nd or 3rd Grade) Pollinators for Healthy Foods (2nd or 3rd Grade) The Three Sisters (2nd or 3rd Grade) Vermicomposting (2nd or 3rd Grade) Field to Fitness (4th or 5th Grade) Plant Picasso (4th or 5th Grade) Vermicomposting (4th or 5th Grade) Water, Soil & The Environment (4th or 5th Grade) Please help me build a "Custom Program" (This is used to combine programs) MIDDLE SCHOOL programs are approximately 2 hours OR 4 hours and topics covered will change based on time. Birds and Bees of Plants (6th - 8th Grade) Careers in Agriculture - (6th - 8th Grade) Forestry (6th - 8th Grade) Plant Picasso (6th - 8th Grade) WWW - Wonderful World of Water (6th - 8th Grade) Cool Chemistry (7th-8th Grade) Please help me build a "Custom Program" (This is used to combine programs) SECONDARY programs are approximately 2 hours OR 4 hours and topics covered will change based on time. Careers in Agriculture - HS (9th - 12th Grade) Cool Chemistry (9th - 12th Grade) How Important is the Soil? (9th - 12th Grade) Introduction to Genetics (9th - 12th Grade) Protein Please (9th - 12th Grade) Please help me build a "Custom Program" (This is used to combine programs) COLLEGE TO ADULT programs are approximately 2 hours. Real Science - Why is being "Green" and the Scientific Method so important? (College) AgroLiquid - Commitment to Environmentally Friendly Products (College) Please help me build a "Custom Program" (This is used to combine programs) In terms of programming, can the IQhub create a lesson or add a topic area that would be relevant to what your students are currently learning?* Briefly describe purpose for visiting the IQhub* Will you be eating lunch at the IQhub?* Yes, we will bring sack lunches Yes, we will arrange for lunch to be delivered No, our trip is not during lunchtime EmailThis field is for validation purposes and should be left unchanged. Stay In Touch with the IQhub Email* NameThis field is for validation purposes and should be left unchanged.
