Geologist Visit Request Form Submitted by lrojo on Tue, 08/16/2022 - 15:54 Indicates required field Your Full Name First Name Middle Name Last Name Your Email Address School/Organization School or Organization Address School/Organization Address Address Line 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Visitation Date Requested Date(s) of Visit Time of Visit Operations Requested Date(s) of Visit Please provide your preferred date plus two (2) alternate dates Time of Visit Virtual or In-Person Visit? Virtual In-Person Please provide us with information about your class or group: Please provide us with the following information: class or group size, grade/age level, schedule: how much time with the class/group, are there multiple classes to be visited? Requested topics to be covered and/or activities to be presented. Please be as specific as possible. Facility Information: parking instructions, building access, available equipment (computer, projection, whiteboard, tables, etc.) Please provide any additional comments, questions, or concerns
