Science on the Screen! Registration

This form is for programming/visits October 2, 2023 through June 7, 2024. To inquire about visits outside of this window, email CISReservations@cranbrook.edu

Submission does not guarantee programming. Our Team will be in contact within 3 days of registration to confirm dates, times, and balance.

Your Group

School/Group Name *

School District *

Address

Address 1 *

Address 2

City *

State *

ZIP code *

County

Email *

Coordinator First Name *

Coordinator Last Name *

Coordinator Title/Role *

Teacher

Administrator

Parent

Librarian

Other

School Phone *

Cell/Evening Phone *

Other Phone

First Preferred Date * “Mon-Fri” *

Date

E.g., 06/09/2024

Second Preferred Date * “Mon-Fri” *

Date

E.g., 06/09/2024

Third Preferred Date * “Mon-Fri” *

Date

E.g., 06/09/2024

How Did You Hear About the Institute's Group Programs? *

Virtual Program Details

Program Choice(s) *

Approaches to Problem Solving - Grades 3-5

Every Rock Has a Story - Grades 6-8

How Did T-Rex Become Ruler of the Dinosaurs? - Grades 3-8

Money! - Grades 3-5

Physics of Fling - Grades 3-9+

Webs, Wings & Crawling Things - Grades PreK-2

What format will you use for the program? *

(Zoom, Webex, Teams, Meet, etc) Links should be emailed to CISReservations@Cranbrook.edu at least 1 week prior to the program date.

Student Location for Virtual Program *

In-school (all students will be in a single classroom for this program)

Remote (each student will be connecting from home to this program)

Hybrid (some students will be connecting from home, others will be in a classroom)

Anything else you'd like us to know? Please detail below.

Any specific requests you'd like to make? Please detail below.

Any special needs we should be aware of so we can accommodate? *

Classroom #1 Information

Class #1 Teacher Name *

Class #1 Teacher Email *

Preferred Class#1 Program Start Time *

Class #1 Grade *

Class #1 Number of Students *

Classroom #2 Information

Class #2 Teacher Name

Class #2 Teacher Email

Preferred Class #2 Program Start Time

Class #2 Grade

Class #2 Number of Students

Classroom #3 Information

Class #3 Teacher Name

Class #3 Teacher Email

Preferred Class #3 Program Start Time

Class #3 Grade

Class #3 Number of Students

Classroom #4 Information

Class #4 Teacher Name

Class #4 Teacher Email

Preferred Class #4 Program Start Time

Class #4 Grade

Class #4 Number of Students

Classroom #5 Information

Class #5 Teacher Name

Class #5 Teacher Email

Preferred Class #5 Program Start Time

Class #5 Grade

Class #5 Number of Students

Deposit *

$100

Leave this field blank