Clemson Extension Youth Stormwater and Watershed Education Program Request Form

Instructions

Please fill out and submit this form to official request an in-school Stormwater and/or Watershed Program. You may request up to two (2) hours of programming per day. Any request exceeding this two hour limit will require the completion of a second request form. Programs are offered M-F between the hours of 9:00 am and 11:30 am. Enviroscape and storm drain marking materials are also available for check out for user led programs.

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* 1. Type of Program(s) Requested (Check all that apply)

EnviroScape Demonstration (25 min)

Stormwater Jeopardy (30 min)

Storm Drain Marking (2 hrs)

4-H2O Curriculum Activities (30 min)

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* 2. Materials Requested for Checkout

Enviroscape Rental

Storm drain marking supplies

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* 3. School or Group Name

Clemson Extension Youth Stormwater and Watershed Education Program Request Form

Instructions

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* 1. Type of Program(s) Requested (Check all that apply)

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* 2. Materials Requested for Checkout

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* 3. School or Group Name

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* 4. Address

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* 5. Contact Info (Name, E-mail Address, Phone Number)

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* 6. Preferred Program Date & Time

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* 7. If no preferred date or time has not been decided, please provide an ideal month and week day that works best for your scheduled program

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* 8. Grade Level

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* 9. Number of Youth

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* 10. Please provide any additional notes including special request, educational standards or questions in this section (Optional)