Educator In-Service @ The Field Museum Request Form

Contact Information

Name of School or Organization *

Group Leader or Primary Contact *

Street Address *

City *

State *

Zip Code *

Phone Number *

Fax Number

Alternative Phone Number *

Please enter your mobile number.

Email Address *

In-service Information

Requested Date of In-Service *

Month

Day

Year

1st choice

Requested Date of In-Service *

Month

Day

Year

2nd choice

Location *

Anticipated Arrival Time *

Anticipated Departure Time *

# of Participants *

Educators-in-training

Certified Classroom Educator

Are you interested in re-certification credit? *

CPDUs (1 CPDU per hour of instruction)

What do you hope your teachers will achieve through this in-service? Please number your interests below, 1 = highest priority – 4 = lowest priority:

	1	2	3	4
Planning and implementing effective field trips to The Field Museum	1	2	3	4
Learning about hands-on resources that can be used in the classroom	1	2	3	4
Developing content knowledge related to the following exhibitions (check exhibition of interest below):	1	2	3	4

The Ancient Americas exhibition (indigenous cultures of the Americas)

Evolving Planet exhibition (history of life on Earth)

Inside Ancient Egypt (ancient Egypt)

DNA Discovery Center exhibition (DNA and scientific research at The Field Museum)

Other

Please type your response if you selected Other above.

Special Requests or Needs (Temporary exhibitions, catering, other):

Other notes:

Educator In-Service Fee Structure (duration = 3 hours)

Group Size	Fee
Fewer than 25 participants	$150
26 – 49 participants	$200
50 – 74 participants	$300
75 – 99 participants	$400

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Educator In-Service @ The Field Museum Request Form

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