2015-2016 Student Mission Reservation Form:
School Information:
School Name:
Address:
City:
County:
State:
District:
Zip:
Teacher/Mission Information
Teacher’s Name:
Phone:
Email:
Good time to contact teacher:
Mission Choice:
Grade Level(s):
Number of students:
Preferred Mission Schedule: (please provide first two choices below)
1st choice Date:
Time:
2nd choice Date:
Time:
Have you gone through our Teacher Training Program?
Yes
No
Time Required for Each e-Mission
Operation Montserrat: 120 minutes
Space Station Alpha: 90 minutes
Fire Scene investigation: 90 minutes
Storm-e, New York/Dayton: 60 minutes
Hurricane Alert! (NEW): 90 minutes
CyberSurgeons (NEW): 90 minutes
Moon, Mars, and Beyond:90 minutes
Target Moon: 90 minutes
M.A.R.S.: 90 minutes
Invoicing Information:
Send invoice to:
Attn:
Street Address:
State:
Email:
City:
Zip:
Technical Information:
Technology Coordinator:
Email:
Phone:
Good time to contact:
Please indicate, by selecting an option below, how you will be connecting with the
Challenger Learning Center?
IP with Video Conferencing Equipment:
IP with Computer & Webcam, (SKYPE):
SKYPE Username: