SurveyMonkey Powered Online Survey

Please complete this form to request a Shedd Aquarium Virtual Field Trip. One program for up to 35 students is $125, and two additional groups (up to 35 each) may be requested for $95 each. All reservation requests must be submitted at least 14 days before your scheduled program.

Requested dates and times are subject to availability. We will notify you when your scheduled program is confirmed.

Question Title

* 1. Teacher's first name:

Question Title

* 2. Teacher's last name:

Question Title

* 3. Primary address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal code *

Teacher's email address *

Teacher's phone number *

School Information

Question Title

* 4. Please identify your school type:

Chicago Public Schools

Chicago, private school

Illinois school

Out-of-state school

Home school

Other (please specify)

Question Title

* 5. School address

School name *

School address *

School address 2

City/Town *

State/Province *

ZIP/Postal code *

School phone number *

Question Title

* 6. Do more than 50% of the students at your school qualify for free or reduced lunch?

Yes