"*" indicates required fields Name of Institution and/or Group*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Name*Contact Phone Number - Cell Number*Contact Phone Number - School Number*Email Address* Total Number of Students*Number of Groups/Classes*Grade Level(s) of Group*Total Number of Chaperones*Names and Emails of Fellow Teachers Attending This Field tripDate Requested - 1st Choice* MM slash DD slash YYYY Earliest time you can arrive at the IQhub?Date Requested - 2nd Choice* MM slash DD slash YYYY Earliest time you can arrive at the IQhub?What time would your group need to leave the IQhub?Would you prefer a morning or afternoon visit?For educators who are returning, would you prefer to have the same program as last school year? Yes No ELEMENTARYSelect a program or tell us what you want to learn and we will create an agenda based on your field trip time parameters. How Do Plants Grow? (Pre-Kindergarten) Apples and Bees (Kindergarten or 1st Grade) Farm to Fork (Kindergarten or 1st Grade) Birds of A Feather (2nd or 3rd Grade) Pollinators for Healthy Foods (2nd or 3rd Grade) The Three Sisters (2nd or 3rd Grade) Vermicomposting (2nd or 3rd Grade) Field to Fitness (4th or 5th Grade) Plant Picasso (4th or 5th Grade) Vermicomposting (4th or 5th Grade) Water, Soil & The Environment (4th or 5th Grade) Please help me build a "Custom Program" (This is used to combine programs) MIDDLE SCHOOLSelect a program or tell us what you want to learn and we will create an agenda based on your field trip time parameters. Birds and Bees of Plants (6th - 8th Grade) Careers in Agriculture - (6th - 8th Grade) Forestry (6th - 8th Grade) Plant Picasso (6th - 8th Grade) WWW - Wonderful World of Water (6th - 8th Grade) Cool Chemistry (7th-8th Grade) Please help me build a "Custom Program" (This is used to combine programs) SECONDARYSelect a program or tell us what you want to learn and we will create an agenda based on your field trip time parameters. Careers in Agriculture - HS (9th - 12th Grade) Cool Chemistry (9th - 12th Grade) How Important is the Soil? (9th - 12th Grade) Introduction to Genetics (9th - 12th Grade) Protein Please (9th - 12th Grade) Please help me build a "Custom Program" (This is used to combine programs) COLLEGE TO ADULTSelect a program or tell us what you want to learn and we will create an agenda based on your field trip time parameters. Real Science - Why is being "Green" and the Scientific Method so important? (College) AgroLiquid - Commitment to Environmentally Friendly Products (College) Please help me build a "Custom Program" (This is used to combine programs) Briefly describe purpose for visiting the IQhub*Will you be eating lunch at the IQhub?* Yes, we will bring sack lunches Yes, we will arrange for lunch to be delivered No, our trip is not during lunchtime Please give us any other information that may be important for your visit (special accommodations; food allergies; etc)PhoneThis field is for validation purposes and should be left unchanged. Stay In Touch with the IQhub Email* EmailThis field is for validation purposes and should be left unchanged.
