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Classroom Visit Request

*Required field

Tell us about yourself

Your Name*:

Email Address*:

Details of the classroom visit request

School Name*:

School Address*:

City*: WA Zip Code*:

Approx. Number of Students*:

Grade Level*:

Pick a date from the week of Dec 18, 2017
Start*: , at :

End*: at :

Event Type*:

Describe specific topic(s) of interest:

Space Description*:

Can you provide a projector for our notebook computer?*
Yes No Maybe

Can you provide a pair of audio speakers for our notebook computer?*
Yes No Maybe

We may take photos or shoot video footage at the event and use the images for educational and promotional purposes. Can you get photo/video release forms from parents and guardians?*
Yes No Maybe

Special Accommodations (Students with disability, etc.):

Can you provide parking for our cars?*
Yes No Maybe

Can you provide us a gas reimbursement?*
Yes No Maybe

Describe a check-in procedure for visitors at your school*:

Comments:

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Tips
Proximity to UW Seattle Campus is preferred.
Schedule your event for evenings or weekends.

We currently cannot bring real brain specimen to our visits. We apologize in advance for any inconvenience.

Please understand that filling this form does not automatically guarantee a visit.