Student Live Workshop Request Form

VIRTUAL PROGRAM REQUEST FORM

Thank you for your workshop request. Please complete the information below, and be sure to click the Submit button when you're finished.

Student Program Logistics

Offered Monday through Friday (weekends available upon request).
Each workshop session may be scheduled for up to 1-hour between 10 am and 5 pm.
Recommended for up to of 30 students in grades 3-12. Contact us if you have more than 30 students. 
The cost is $50.00 per session. Full payment required within 7 days of the workshop date. Scholarships are available on a need basis.

Please email Sana Ahmed at education@laconservancy.org for more information. Ask us about adapting workshops to fit your classroom's distance learning needs!

STUDENT PROGRAM SELECTION DETAILS

PROGRAM CHOICE If you have a question about which workshop would be best for your group, please refer to www.laconservancy.org/back-school for more information or contact Sana Ahmed at sahmed@laconservancy.org.*

PREFERRED PROGRAM DATE*

ALTERNATE DATE

Program Time (Workshops may be scheduled for up to an hour between 10am to 5pm. Please indicate a start time frame (i.e. 10 am )*

CONTACT INFORMATION

Name of School or Organization*

Are you a home school? *

Yes

Street*


City*	State*


Postal Code*	Country*

First Name*	Last Name*


Email Address*

Phone Number*

Same as day of contact?*

Yes

If NO:

Day of Contact First Name	Day of Contact Last Name

Day of Contact Email

Day of Contact Phone Number

INFORMATION ABOUT YOUR STUDENT GROUP

ESTIMATED NUMBER OF STUDENTS (There is a 30-student maximum. Please contact Sana Ahmed at sahmed@laconservancy.org if you have more than 30 students.) *

Number of Adult Supervisors (18+)

GROUP GRADE LEVEL - Check multiple boxes, if necessary*

Elementary School (Grades 3-5)

Middle School (Grades 6-8)

High School (Grades 9-12)

Are you a Title 1 School?*

Yes

Limited scholarships for groups needing assistance may be available. Would you like more information about this assistance?*

Yes, please contact me

No thank you

Special Requests or other information about your group

Programs are subject to availability. Press the Submit button below to request your reservation.

Program requests will be reviewed within five business days. All requests will receive a follow up email or phone call. We will advise you if we cannot accommodate your group. Groups whose requests can be accommodated will receive a booking confirmation with details. IF YOU DO NOT RECEIVE A CONFIRMATION, YOUR GROUP IS NOT ON OUR CALENDAR.

For more information contact Education Specialist, Sana Ahmed at sahmed@laconservancy.org.