Country Doctor Museum

Educational Program Request Form

Name
Phone Number
Email Address
School
What grade level(s) do you teach?
What subject(s) do you teach?
How many students do you teach (approximately)?
What internet access do your students have in the classroom or at school?
How much time were you allotting for the lesson? (e.g.-45 minutes for three different sections of the same class plus an additional 25 minutes for background material, etc...)
Briefly describe what student need, unit, or standard you are addressing. (We offer various programs, but are more than willing to provide immediate classroom ready resources and ideas.)