Mobile Outreach Reservation Request | Natural History Museum of Los Angeles

Contact Information

* = required field
* First Name:
* Last Name:
* Title:
* Are you an administrator?	Please Specify No Yes
* Administrator Name:
* School Name:
* Principle's E-mail:
* Education Service Center:	Please Select ISIC East ESC North ESC West ESC South ESC
* School Street Address:
School Street Address 2:
* School City:
* School Zip Code:
* School Phone:
* Alternate Phone we can reach you at:
* E-mail:	Check to be added to our teacher email list. You will be added to our teacher e-mail list.

Mobile Museum Visit Details

* Select a Mobile:	Please SelectEarthmobile (Grades 3, 4 & 5)Seamobile (Grades 6-8)Skymobile (Grades 4 & 5)
The Skymobile program has been retired! This mobile may be reinvented as a new program for primary grades. Do you have an idea for a theme for this mobile? Email us at mobileoutreach@nhm.org!
Grade Level(s) & Number of Classes:
* 1st Group:	Num of Classes:
2nd Group:	Num of Classes:
3rd Group:	Num of Classes:
Please note any Special Needs or GATE classes:
Are there any weeks in the school's master calendar that we CANNOT schedule the Mobile to visit your school site? (For example, please list dates of testing weeks or parent conferences as well as school holiday celebrations)
Please note that schools scheduled to receive the Earthmobile between the months of August through March may be eligible for a follow-up visit to the Natural History Museum with subsidized bus transportation and guided tours for each participating class.
* Are you interested in a follow-up visit to the Natural History Museum?	Please choose Yes No

Logistics

In order to be eligible for this program, our modified tractor-trailers must be able to access and park on a level, flat surface that is secure (on an asphalt schoolyard or parking lot)
Please note any current or future construction around your school site:
Once a request has been conditionally accepted, our NHM drivers will do a site check to confirm that we can serve your school.
* Name of Plant Manager:
* Phone:

You have successfully sumitted a request for our program.

After completing this form, please email the following documents to mobileoutreach@nhm.org:

• Bell schedule
• Map of school ground
• Teacher roster

We will need this information to complete your scheduling request.

Thank you for your interest in our outreach programs! Please allow up to 1 month to process your request.