Form

Design Your Own: Pre-Service Teachers
Request Application Form

Please fill out this form to request your session at the Museum. We will contact you via email to confirm scheduling and payment information within 48 hours.
Course you are requesting (check box)*

Pre-Service Teacher Session
School or Organization*
School District (if applicable)
Group Leader or Primary Contact*
First Name Last Name

Mailing address (confirmation will be mailed here)*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

County*
Phone*
- Area Code Phone Number
Fax Number
- Area Code Phone Number
Alternate Phone
- Area Code Phone Number
E-mail*
Requested date (1st choice)*
/ Month / Day Year
Requested date (2nd choice)*
/ Month / Day Year
Anticipated Arrival Time*
Anticipated Departure Time*
Number of participants in your group*
Are you interested in receiving a certifcation for professional development clock hours?*

Yes No
Program Request Options - please check which program you are interested in attending. (See Option descriptions below)*

Introduction Pre-service Teacher Training Option A (45 minutes) Introduction Pre-service Teaching Training Option A plus IMAX/Planetarium General Pre-service Teacher Training Option B (Up to 1.5 hours) General Pre-service Teaching Training Option B plus IMAX/Planetarium
Option A: Introduction Teacher Training (45 minutes)

• Basic Museum admission for the day • Resource packets for participants • Introduction to Museum education resources • Ideas for hands-on activities
Option A + IMAX or Planetarium (up to 1.5 hours)

An IMAX or Planetarium show can be added to this program for an additional $3.50/per person for the Planetarium or $5.00/per person for IMAX.
Option B: General Teacher Training (up to 1.5 hours)

Same as Option A with your choice of a permanent exhibit•Visit to a permanent exhibition using an Exhibit Activity Guide (North American Indian Cultures,Prehistoric Journey, or North American Wildlife Hall) or a visit to Space Odyssey or Expedition Health OR hands-on activities that meet specific goals stated in your request form
Option B + IMAX or Planetarium (up to 2.5 hours)

An IMAX or Planetarium show can be added to this program for an additional $3.50/per person for the Planetarium or $5.00/per person for IMAX.
If you are selecting an IMAX option, indicate the time you wish to go. (Choose one time slot only, please)

10:30 am 2:00 pm 4:00 pm 11:30 am 3:00 pm 5:00 pm 1:00 pm
If you are selecting a Planetarium option, indicate the time you wish to go. (Choose one time slot only, please)

10:00 am 1:30 pm 4:00 pm 11:00 am 2:30 pm 5:00 pm 11:30 am 3:30 pm
What subjects do participants' teach or intend to teach? Select all that apply*

General Social Science Science Language Arts Math Fine Arts Other
If "Other", please specify
What grade level do participants' teach or intend to teach? Select all that apply*

Grades preK-2 Grades 3-5 Grades 6-8 Grades 9-12 Other
If "Other", please specify

What do you hope to achieve through this professional development visit? Please order the following items from 1 to 3 in order of priority in which you'd like them to be covered (1 being most important to cover and 3 being least important to cover).*

	Most Important	Important	Least Important
Planning and implementing effective field trips to DMNS
Learning about hands-on resources that can be used in the classroom
Developing content knowledge related to the following exhibitions exhibition of interest

If developing content knowledge related to exhibitions is a subject you want us to talk about, what exhibits interest you?*

Discovery Zone (ECE learning exhibit) Egyptian Mummies (ancient civilization of Egypt) Expedition Health (YOUR human body) Gems & Minerals (tunnel beneath the Earth) North American Indians Culture exhibit (Native American groups) Prehistoric Journey exhibition (trace the evolution of life on Earth) Space Odyssey (explore the universe) North American Wildlife Exhibit (diorama hall)
Special Requests or Needs - at added expense (Temporary exhibition tickets, catering, other)
Specific goals*
How did you find out about this course?

DMNS website CSEN/Sci-co listserv DMNS e-Newsletter Colleague Flyer
Enter the message as it's shown*
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Design Your Own: Pre-Service Teachers

Request Application Form

Option A: Introduction Teacher Training (45 minutes)

Option A + IMAX or Planetarium (up to 1.5 hours)

Option B: General Teacher Training (up to 1.5 hours)

Option B + IMAX or Planetarium (up to 2.5 hours)