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Mojave Max Environmental Education
Application Form Classroom Program
Grade 3 or Grade 6 Chair:
Please complete one application on behalf of all of the interested teachers at your grade level.
This means one submission per school.
For Fall 2006 presentations, all requests should be received no later than September 4th.
Note to year-round schools: We will be doing limited presentations this summer.
Contact the project coordinator as soon as possible if interested.
Please send completed forms to:
Stacy Irvin, Mojave Max Project Coordinator at sirvin@interact.ccsd.net
or fax to 258-7599.
Submission of this form does not automatically guarantee selection for a classroom visit. Selection is made by lottery.
School: ___________________________________________Circle one: 9 / 12 month
Contact teacher: ______________________________Circle one: Grade 3 / Grade 6
Number of classes:_____ Number of students per class (approximately):________
School phone: _____________________School fax:________________________
Contact teacher’s Interact address: ______________Other e-mail address:_____________
School mailing address: _________________________City: ___________Zip:_______
Which track will you be on for the school year? ___________
Time school begins:_____________ and ends: ____________
Time Lunch begins:_____________ and ends: ____________
Circle the month and the days of the week preferred:
June July August September October November
Monday Tuesday Wednesday Thursday Friday
If you would like to request a specific date, please indicate here:___________________
Before submitting any dates, please check your school calendar for conflicts.
If you have any questions, please call Stacy Irvin at 258-7097 or 501-8060.
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