Lesson Request Form

Please complete all required fields below using appropriate word casing to make information clear.

School District (if private, put school name here; if home school, put your name here)

District Phone (if private school, put school number here; if home school, put your number here)

Name of School (if private school, put name here; if home school, indicate that)

School Phone (if home school, put your number here)

School Mailing Address (if home school, put your address here)

School City

School State

School Zip

Teacher Name

Teacher Email

Teacher Phone

Have you participated in a GSP Lesson before?

Yes No

Grade Level

Total Number of Students

Special Needs (Example: mobility, ELL, etc.)

Lesson Title

Unit Being Studied

At what point are you in the unit?

Dates Requested: Provide 3 dates in order of preference.

Date 1

Date 2

Date 3

Arrival Time (no later than 2:00 pm)

Will you bring a snack to eat along the trail?

Yes No

Will you be staying for lunch?

Yes No

How will you fund your visit?

56 Game Farm Rd., Delmar, NY 12054
For Educational Program Information, email: education@FriendsofFiveRivers.org
For General Information, email: info@FriendsofFiveRivers.org
Phone: (518) 475-0295

Charitable Tax ID# 23-7309978