Outreach Program Request Form

This request is for a:(Required)

School name(Required)

School district(Required)

County(Required)

Group name(Required)

Your name(Required)

Your position(Required)

Your email address(Required)

Your phone number(Required)

Your mailing address (street, city, ZIP)(Required)

Is the address above the location of the program?(Required)

Where will the program take place?(Required)

What program are you requesting?(Required)

Date and time requested for program(Required)

(Dates available November-April)

Date and time requested for program(Required)

(Outreach programs not available in May or October)

Alternate date and time if above is unavailable

Estimated attendance(Required)

(Maximum 30)

Estimated attendance(Required)

(Maximum 50)

Grade level of students(Required)

Brief description of your group(Required)

Mission/purpose, demographics, etc.)

Are there any special needs we should be aware of to make this outreach successful?

Are you able to provide a table for artifacts and a projector/screen?(Required)

Thank you for requesting an Outreach Program from Living History Farms. You will receive an automated email confirming this request, and then a member of our staff will contact you to confirm your program and make arrangements for payment.

Living History Farms Outreach Request