S.T.R.A.N.D. Request Form

Scientists with Traveling Resources and Neat Demonstrations

This form is used to request a scientist or engineer to come to your classroom. These volunteers are limited to 35 children per group, however, you may request that they work with more than one group during the day. All requests should be received at least THREE weeks prior to the time frame you are requesting. Please wait for written confirmation before planning further.

Today's Date _____________________________

Name_____________________________________ Grade Level _____________________________

School ____________________________________ No. of Students __________________________

Address __________________________________________________________________________

Subject ___________________________________ Room Number___________________________

Email: ___________________________________________________________________________

School Phone ______________________________ Home Phone ____________________________

School Fax _______________________________ Best Time to Call __________________________

Time Frame Requested (a range of dates is best) ___________________________________________

Time of Day Requested ______________________________________________________________

Demonstration Requested ____________________________________________________________

Teacher's Signature ________________________________________________________________

Principal's Signature _______________________________________________________________

Please complete and return to:

John Hutchens
Traveling Science and Mathematics Demonstrations Program
Ruth Patrick Science Education Center
471 University Parkway, Box 3
Aiken, SC 29801

803-641-3474 * FAX 803-641-3615

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Copyright © 2010 by the Board of Trustees of the University of South Carolina.

Ruth Patrick Science Education Center
Center of Excellence in Educational Technology
University of South Carolina Aiken
471 University Parkway
Aiken, SC 29801