EIC Scheduler

Teacher/Group Leader last name*

Teacher/Group Leader first name*

Teacher/Group Leader email address*

Confirm Teacher/Group Leader email address*

Teacher cell phone number* (Required format: xxx-xxx-xxxx)

Good time to reach Teacher/Group Leader by phone* (If email preferred, please enter "Email preferred")

School*

Grade level(s)*

Number of students in your group* (We request a minimum of 10 students and a maximum of 70)

Number of adult chaperones* (We request a minimum of 1 adult chaperone per 10 students)

Preferred date(s) and start time(s)

1st preference*

2nd preference

3rd preference

Is your group bringing lunch? (Lunch is not provided by the University)

Does your group require any special accommodations?

Please make sure that you submit your program request. You will receive a confirmation email upon successful submission of your program request.