Rivers Are Alive Program Info RequestPlease complete this form to reserve a Rivers Are Alive program for your school. If you have any questions, please email firstname.lastname@example.org.Step 1 of 250%Educator Name* First Last School Name*School Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Enter Email Confirm Email Number of Students*Number of Teachers*Number of Chaperones*Grade Level* Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 High School (9 -12)Type of Program* 1 hour classroom Half day - classroom (2 hours or more) Half Day Field Trip (Morning or Afternoon) Whole Day Field Trip Wild River Journey Riverboat Field Trip (2 hours) Custom paddling trip (grades 9 - 12)Program date preference* Date Format: MM slash DD slash YYYY Other possible dates for programWhat accommodations do you need to support students with special needs?How will this field trip meet your curriculum goals?How did you hear about Rivers Are Alive?*National Parks Service websiteNational Parks Service social mediaSt. Croix River Association websiteSt. Croix River Association social mediaRivers Are Alive brochureMy school has been participating in this programFrom another educator/word of mouthEducator In-Service Workshop My school is interested in a Rivers Are Alive educator in-service workshop School DemographicsOptional, but completing this section helps to keep Rivers Are Alive programs free and is useful for grant applications.School Title One StatusFree and Reduced Lunch PercentageSchool DemographicsPlease indicate percentage.Hispanic or LatinoAmerican Indian or Alaska NativeAsianBlack or African-AmericanNative Hawaiian or other Pacific IslanderWhiteTwo or more racesSignature*EmailThis field is for validation purposes and should be left unchanged.