A completed application will include Teacher and Administration Sections. Applications which are incomplete in any area will not be considered or accepted to SciencEscape. Recommendation must be sent no later than Friday, March 2, 2018. Only 4 Groups of Teachers and Students will be selected for this science adventure! Finalists may be contacted to complete a telephone interview. Teacher/School Information Teacher Name School Name School Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code County School District SciencEscape travels to schools in the school districts listed below. Schools outside those districts are welcome to apply, but must provide transportation to and from the Sam Noble Museum. (Please select one option) My school is in the Norman, Moore, South OKC, Newcastle, Robin Hill, Little Axe, Blanchard, Midwest City-Del City, Western Heights, Washington, Purcell or Noble School Districts. SciencEscape will provide transportation.My school is able to provide transportation to and from the Sam Noble Museum on the day of the program. All other program transportation will be provided by SciencEscape. Will your facility be available for use during the program (student pick-up/drop off, one classroom for activities)? YesNoNote: SciencEscape takes place on one day during Spring Break week (March 14-18, 2016) at your school and the Sam Noble Museum. School Phone Personal Phone Teacher Email Address How many students attend your school? What percentage of students at your school receive free/reduced lunch? Group Information Grade(s) of Students Estimated number of participating students Minimum 8, Maximum 15 Comments Why are you, personally, interested in participating in SciencEscape? Define science in your own words and describe why you like science. This is an outdoor science program. Would you be comfortable working with your students in an outdoor nature setting (ponds, streams and/or forests)? Please explain. Does your school offer any science-based programming (science clubs, science fair competitions, or other extra-curricular science opportunities)? If so, please describe. Are you or any of your students involved in these opportunities? Why would you like your students to participate in this program? Briefly describe your group of students. Are there any special needs or considerations for your group? Please tell us why your group should be selected for this program. Would the parents of your students be willing and able to drop-off and pick-up students at your school on the day of the program? Please rank the following program dates in order of preference: First Preference Date ---Monday, March 13Tuesday, March 14Wednesday, March 15Thursday, March 16 Second Preference Date ---Monday, March 13Tuesday, March 14Wednesday, March 15Thursday, March 16 Third Preference Date ---Monday, March 13Tuesday, March 14Wednesday, March 15Thursday, March 16 Fourth Preference Date ---Monday, March 13Tuesday, March 14Wednesday, March 15Thursday, March 16 No Preference Date My group is available any day, please assign us a day.