SCENIQ Application Form: 2017-2018

SCENIQ Application Form: 2017-2018

Thank you for your interest in the SCENIQ (Students Conducting Environmental Inquiry) program at Pepperwood Preserve. We are delighted to offer this highly acclaimed program to local classes. This 9-hour program consisting of 2 field trips and a classroom visit, greatly enhances students’ understanding and appreciation for science and nature.

School Name:______Address:______

School Phone Number: ______Grade Level: ______# Students/Grade ______

Please note that schools must apply by grade band (i.e. all 4th grade teachers at the school).

*Contact Teacher: ______Email: ______Cell:______

Teacher Name: ______Email: ______Cell:______

Teacher Name: ______Email: ______Cell:______

Teacher Name: ______Email: ______Cell:______

Are there any other field trips your students will do this year? Please write them below:

______

Why do you want to participate in the SCENIQ program with your students?

Please describe how you plan to integrate the SCENIQ (Students Conducting Environmental Inquiry) program into your curriculum:

Has your school participated in our SCENIQ program before? Y N # of years ______

Do you want to be added to our mailing list? YesNoAlready signed up

Our programs are subsidized by donations and are offered on a sliding scale from $200-$600 per classfor the school year (2 field trips and 1 classroom visit plus teacher support materials). Please enter the amount you will pay for the SCENIQ program: $______. If you are applying for a full or partial bus scholarship you do not need to fill this out.

Dates for Field Trips

Please note that our field trips are 9:15am-1:15pm onTuesdays, Wednesdays, and Thursdays only. Please list any black out dates or minimum days below, and we will assign you your field trip date based on availablility. You do not need to include holidays or holiday breaks. Please plan on staying for the full 4 hours of your field trip.

If you teach 1st or 2nd grade, you will have your field trip in November or December and May.

If you teach 3rd or 4th grade, you will have your field trip in October or Novemberand April.

If you teach 5th grade, you will have your field trip inSeptember and March.

I cannot come to Pepperwood on the following dates/days of the week in my assigned months:

1-hour Winter School Visit Date (January, February): Wednesdayor Thursday

1st Choice: 2nd Choice: 3rd Choice:

All Classes: ______

*Please note that our educators visit all classes on the same day when we come to your school, unless you have 4 classes. We will need 2 dates for 4 classes (2 each day). We will schedule the 1-hour classroom visits for each class after we confirm the date.

We have developed curriculum for a 9-hour program, and we have to fulfill that commitment to our grant funders.

Yes! My class will stay for the full field trip (4 hours) and I will bring no more than the number of students that I have applied to bring on this application. I will not add students from other classes (all teachers must sign this for the application to be processed). I understand that failure to adhere to this agreement may make my school ineligible for SCENIQ in the future.

Signature: ______

______

Please return completed form by August 1, 2017, via email: ),

or mail: 2130 Pepperwood Preserve Road, Santa Rosa, CA 95404.

You will be notified by mid-August whether you have been selected to participate in SCENIQ. Thank you!

2130 Pepperwood Preserve Road, Santa Rosa, CA 95404 | (707) 591-9310 |