Secondary Education Program Form

Your Information

First Name*

Last Name*

Email*

Telephone*

School Information

School Name*

School District*

School Address*

Grade Level - check all that apply
 6 7 8 9 10 11 12

Program Information

Program Selection:

 From Slavery to Freedom Eyewitness to History Materials Matter: Analyzing and Preserving Documents Glass: Shattering Notions History’s Sandbox Studio at the Detre Library & Archives Healthy Heritage Community Case Studies


Number of Students*

Number of Classes*

Number of Teachers*

Number of Chaperones*

Preferred Dates*
1.

2.

3.

Time of Arrival*:

Time of Departure*:

Lunch Choices:  No lunch Brown bag lunch (lunchroom space provided) Box lunch from the Museum Café (lunchroom space provided)

Would you like students to visit the Museum Shop?

 Yes No