Teacher Input Form Company School District * School Name * School Street Address * School City * School State * Select a State/ProvinceAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory School Zip Code * School Phone * Teacher Name * Teacher Email * Teacher Cell Phone * Have you participated in a GSP Lesson before? * Yes No Grade Level * Total Number of Students * Special Needs (Example: wheelchair accessibility, ELL, etc.) * Season * Fall Winter Early Spring (March) Spring Unit Being Studied/Tie-In with Classroom Instruction At what point are you in the unit? * Starting Point Mid Unit Conclusion Dates Requested: Provide 3 dates in order of preference. Date 1 * Date 2 * Date 3 * Arrival Time * 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? * PTO/PTA Check NY Connect Kids Reimbursement Grant Friends Scholarship BOCES Arts in Education and Exploratory Enrichment Program
