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School Name*
School Address (including city, state and zip code)*
County*
School Phone*
Teacher's Name*
Contact Cell Phone*
Contact Email Address*
Student Grade Level*
Number of classes requesting a connection/number of connections needed*
Number of students per class*
Total number of students*
Connection Type*
Virtual Program Requested:*
- Westward Ho! (grade 1)
- American Indians: Cherokee (grade 2)
- Booth Blazers (grades 2-12)
- American Indians: Cultures and Contributions (grade 3)
- Westward Ho! (Grade 4)
- Full STEAM Ahead! (grades 4 – 8)
- Exploring the West (grade 5)
Date (First Choice)*
MM slash DD slash YYYY
Date (Second Choice)
MM slash DD slash YYYY
Date (Third Choice)
MM slash DD slash YYYY
Request Start Time*

: Hours

Minutes

AM/PM
Tech Contact Name*
Tech Contact Email*
Tech Contact Phone Number*
Does your school prefer Zoom, Google Meet or Microsoft Teams? (Zoom is our preferred platform)*
Do you prefer to use your classroom/school’s virtual room (you provide us a link to connect) or our room (we provide you a link to connect)?*
Please provide all participating teacher's email addresses.*
Additional Notes