Virtual Field Trip Request Form

View from the stage of Ford’s Theatre. Photo © Maxwell MacKenzie.

Virtual Field Trip: Request Form

Please submit this form to request a virtual field trip for your class or group.

Contact Name(Required)

First Last

Contact Email Address(Required)

Contact Phone Number

Contact Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This is my(Required)

School/Business Address

Home Address

What Program Would you like to Request?(Required)

How Many Participants?(Required)

School or Business Name

School or Business Website

My school is a Title 1 School.(Required)

Yes

Unsure

In my school, 40% or more students are eligible for Free and Reduced Meals.(Required)

Yes

Unsure

What Grade or Age Level are the Participants?(Required)

First Choice Date : MM/DD/YYYY(Required)

First Choice Time(Required)

Time Zone(Required)

Second Choice Date : MM/DD/YYYY(Required)

Second Choice Time(Required)

Time Zone(Required)

How would you like to connect? Our preferred platform is Zoom, but we can also join you in your virtual classroom.(Required)

If you selected Custom Connection, please describe what you would like to request:

Do you have any other comments, questions or accommodation requests?

Would you like to subscribe to our Enews for Teachers?(Required)