Program Information Request Form * 1. Address Name School/Company Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address * 2. Group Type School Group (K-12) Undergraduate FSU Factly/Staff Out of School Time Group (Clubs, Camps, Enrichment Programs) Corporate Group Non-Profit Group * 3. What program(s) are you interested in? Challenger Learning Center (5th grade and above) Planetarium Challenger and Planetarium (5th grade and above) * 4. Number of Students/Participants * 5. What month(s) are you interested in? January February March April May June July August September October November December Please Note: The programs for Out-of-School Time and Community groups are offered on Tuesdays or Thursdays after 2:00pm. We also offer programs on the First or Second Saturday of each month. * 6. What grade are your students? Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12 Other (please specify) Done
