Oregon Garden Natural Resources Education Program Contact Information Teacher Name Email Address Phone Number (include area code) School Name School District School Street Address School City County No Oregon CountyBaker CountyBenton CountyClackamas CountyClatsop CountyColumbia CountyCoos CountyCrook CountyCurry CountyDeschutes CountyDouglas CountyGilliam CountyGrant CountyHarney CountyHood River CountyJackson CountyJefferson CountyJosephine CountyKlamath CountyLake CountyLane CountyLincoln CountyLinn CountyMalheur CountyMarion CountyMorrow CountyMultnomah CountyPolk CountySherman CountyTillamook CountyUmatilla CountyUnion CountyWallowa CountyWasco CountyWashington CountyWheeler CountyYamhill County School State - Select School State -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming School Zip Code Date and Times Preferred Date of Field Trip Alternate Date of Field Trip Arrival Time Departure Time Class Info Grade(s) Number of Students Number of Teachers Name of second teacher (if applicable) Email of second teacher Name of third teacher (if applicable) Email of third teacher Number of Adult Chaperones (1 adult per 5 students, minimum) Are you a Title 1 school? (Scholarships are available. Please inquire.) Yes No Wheelchair or other access requirements Yes No Please Describe ESL Needs Yes No Please Describe Program Interest Areas Wildlife Habitat Food Webs in Ecosystems Plant and Animal Adaptation Healthy Forest Bus Support Amount Requested for Transportation Support $ (school district will not be reimbursed over approved amount). Reimbursements are for up to $600 for school buses only please. After a review of your application, we will contact you to discuss the details of your trip and you will receive a confirmation packet. Payment Requirements I acknowledge that a payment of $3 per student will be given to the Oregon Garden Foundation upon completion of the field trip Yes Have you participated in this program before? Yes No
Contact Information Teacher Name Email Address Phone Number (include area code) School Name School District School Street Address School City County No Oregon CountyBaker CountyBenton CountyClackamas CountyClatsop CountyColumbia CountyCoos CountyCrook CountyCurry CountyDeschutes CountyDouglas CountyGilliam CountyGrant CountyHarney CountyHood River CountyJackson CountyJefferson CountyJosephine CountyKlamath CountyLake CountyLane CountyLincoln CountyLinn CountyMalheur CountyMarion CountyMorrow CountyMultnomah CountyPolk CountySherman CountyTillamook CountyUmatilla CountyUnion CountyWallowa CountyWasco CountyWashington CountyWheeler CountyYamhill County School State - Select School State -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming School Zip Code Date and Times Preferred Date of Field Trip Alternate Date of Field Trip Arrival Time Departure Time Class Info Grade(s) Number of Students Number of Teachers Name of second teacher (if applicable) Email of second teacher Name of third teacher (if applicable) Email of third teacher Number of Adult Chaperones (1 adult per 5 students, minimum) Are you a Title 1 school? (Scholarships are available. Please inquire.) Yes No Wheelchair or other access requirements Yes No Please Describe ESL Needs Yes No Please Describe Program Interest Areas Wildlife Habitat Food Webs in Ecosystems Plant and Animal Adaptation Healthy Forest Bus Support Amount Requested for Transportation Support $ (school district will not be reimbursed over approved amount). Reimbursements are for up to $600 for school buses only please. After a review of your application, we will contact you to discuss the details of your trip and you will receive a confirmation packet. Payment Requirements I acknowledge that a payment of $3 per student will be given to the Oregon Garden Foundation upon completion of the field trip Yes Have you participated in this program before? Yes No
