Request for Outreach Program

Thank you for your request! Please note, submitting this form does not guarantee an outreach reservation. Staff will respond to your request, book your appointment, then send written confirmation of that appointment. Fields marked with an asterisk (*) must be filled out completely.

Primary Contact's Information

Name *

First

Last

Title

Email *

*Some school district servers block outside emails. If you're emailing from a school, using an alternate email address may make communications with The Schiele more successful.

Best Contact Number *

Organization Information

Organization Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Organization Phone *

Organization Fax

# Classes Attending *

# Students Attending *

Proposed Date(s) of Visit

Program Preferences When selecting multiple programs, please indicate in the comments section if you would like multiple programs on the same day or if you are looking to schedule multiple outreach programs on different days.

First Program Selection *

Second Program Selection (if interested)

Third Program Selection (if interested)

Requested Program Date *

Requested Program Time *

Alternate Program Date (2nd choice)

Alternate Program Time (2nd choice)

Alternate Program Date (3rd choice)

Alternate Program Time (3rd choice)

Special Needs / Requests / Comments

Subscribe to E-news* *

The Schiele Museum is committed to inspiring curiosity and understanding of science and the natural world.

MUSEUM OPEN DAILY
Monday – Saturday 10 AM – 4 PM
Sunday 1 – 5 PM

Request for Outreach Program

Primary Contact's Information

Organization Information

Proposed Date(s) of Visit

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