Education Programs Form

Please use this form to request an “Experience History” program at the Heinz History Center.

    Your Information

    First Name*

    Last Name*

    Email*

    Telephone*

    School Information

    School Name*

    School District*

    School Address*

    School City, State, ZIP *

    Grade Level - check all that apply
    Pre-KK123456789101112

    Program Information
    Please note that not all programs are available for all grades. Please refer to the Experience History Programs guide for more information.

    Arsenal of the Union: Western Pennsylvania in the Civil WarUnderground Railroad in Western PennsylvaniaConflicts and Compromises: Pittsburgh’s Labor HistorySetting the Scene: Macaroni BoyCaring for Community: Jewish History in PittsburghEyewitness to HistoryShaping Modern Pittsburgh: A Deliberative Forum90 Pittsburgh NeighborhoodsGather a StoryA Better World: Improving the Quality of our Lives Through InnovationInnovation and InventionTo the Moon and Back: Pittsburgh and the Apollo 11 MissionHands On History - Exploring Original Primary Sources


    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 lunchBrown bag lunch (lunchroom space provided)Box lunch from the Museum Café (lunchroom space provided)

    Would you like students to visit the Museum Shop?

    YesNo

    Does your group have any special needs or accommodations?

    Transportation
    School busMotor coachVan or carPublic transportationOther

    Lunch Choices: No lunchBrown bag lunch (lunchroom space provided)

    Would you like students to visit the Museum Shop?

    YesNo

    Add Special Needs or Accommodations*

    My group includes:

    Students with sensory sensitivitiesStudents who are deaf or hard of hearingStudents with vision lossStudents with intellectual disabilitiesStudents who are non-verbalStudents who are non-readersStudents who have limited motor skillsStudents who require extra time for tasksEnglish language learnersA person who uses a wheelchairMy group does not need any of these accommodations

    Is there anything else you want to tell us about your group?

    Do you want to sign up for the History Center's teacher email newsletter?

    YesNo