Field Experience Request

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Today's date: *

Month

Day

Year

wf

Contact name: *

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Contact email: *

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Contact phone: *

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School: *

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Number of students: *

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Number of adults? (teachers/chaparones) *

wf

PreK should have a 1 to 2 ratio, K-5 should have a 1 to 5 ratio, secondary should have a 1 to 10 ratio

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Grade level: *

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District: *

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From: *

Month

Day

Year

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To: *

Month

Day

Year

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Time of arrival: *

:

am

pm

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Time of departure: *

:

am

pm

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Will this experience take place at the Poudre Learning Center? *

Yes

Other - Please list location:

Will this experience take place at the Poudre Learning Center? Other - Please list location:

Field experience date:

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