Due Sept. 5, 2008 by 5:00 pm.
Please fill out this form carefully and completely. Teachers selected for a free visit will be notified by mail the week of September 15, 2008.

All fields with an * are required. Please complete all fields.

Your Information
Teacher Name:*	Grade Level:*
Teacher E-mail:*
School:*	%Title 1 students:
School Address:*
City:*	County:*
State:*	Zip:* School District:
School Phone: *	School Fax:
Home Phone:

Workshops

All teachers planning to attend with their class must be listed on the application and attend a teacher workshop prior to their class visit. Select a minimum of three workshops, in order of preference, from the list of teacher workshops. If you have already attended a workshop, indicate the academic year (00-01, 01-02, etc) and your name. (Please indicate any name changes.)

Teacher Name	Workshop Date, Time & Location (if not previously attended)	Grade Level	No. of students
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Plan your Aquarium Visit
Programs are offered October 14 - March 20.
When selecting the dates of your visit, remember programs are NOT OFFERED: Nov 26-28, Dec 15-Jan 2, Jan 19, Feb 16.

Total # of students: Total # of Classes:
Please list the best dates/times for your class to visit in order of preference. Include the number of students participating at each time.

	EXAMPLE	1st choice	2nd choice	3rd choice
Date	10 / 22
# of Students 9:30	70
# of Students 11:00	27

I'll take any date and time available in your calendar, Except on the dates for the following events (please list specific dates):

Please list any dates which you are NOT available for programs

If you students will be participating in the 11 a.m. program, please designate their self-guided tour time:

How many times have you previously applied for our FREE Standards-Based Structured School Programs?

How many times have you been awarded a FREE Standards-Based Structured School Program?