Environmental Education Request & Application Form

2. Instructions
   <p style="line-height:125%">Please fill out and submit the form. Once we receive it, we will schedule a conversation with you and any other teachers/members of your team. Together we will build a custom set of lessons that best fit your curriculum and our collective resources. </p><br> <p style="line-height:125%">Our lessons plus the project you choose make up the complete program.</p>

   Please fill out and submit the form. Once we receive it, we will schedule a conversation with you and any other teachers/members of your team. Together we will build a custom set of lessons that best fit your curriculum and our collective resources.

   
   

   Our lessons plus the project you choose make up the complete program.

6. Lead Contact Name*

7. Title

9. School or Organization

10. School District (if applicable)
    -- Select One --AuburnBethelCarbonadoClover ParkDieringerEatonvilleFifeFranklin PierceOrtingPeninsulaPrivate SchoolPuyallupSteilacoomSumnerUniversity PlaceWhite River

12. Email Address*

13. Phone Number

15. Mailing Address

17. City

18. State

19. Zip

21. Type of Audience

    1. Students

    1. Club/Organization

    1. Faculty/Staff

    1. Other

23. Other Audience Type

25. Grades or Age Range

26. Number of classes or groups

28. Approximate number of students in each class or group

30. How did you hear about us?

32. Other Teachers/Team Members Involved in This Program

34. Name

35. Email

37. Name

38. Email

40. Name

41. Email

43. Name

44. Email

46. Name

47. Email

49. Name

50. Email

52. Name

53. Email

55. Name

56. Email

60. Program Theme*

    Choose a theme based on your needs and the kind of project you would like to do.

    1. Composting/Worms/Garden
    2. Resource Conservation/Recycling
    3. Water
62. Composting/Worms/Garden
    Ecosystems, life cycles, identifying organisms, composting technology

    Ecosystems, life cycles, identifying organisms, composting technology

63. Resource Conservation/ Recycling
    Resources and recyclables, Pierce County's solid waste system, landfill technology and design, waste analysis, ecological footprints

    Resources and recyclables, Pierce County's solid waste system, landfill technology and design, waste analysis, ecological footprints

64. Water
    Consumption and conservation, healthy habitat, impacts of pollution, water systems, energy sources

    Consumption and conservation, healthy habitat, impacts of pollution, water systems, energy sources

66. For teachers, how would you like to connect our lessons to your classroom curriculum?
    For organizations, what goal are you trying to accomplish with our lessons?

68. What ideas do you have for your community action project or service learning project?

70. Are there community partners who can help with this project?

72. What time of year would you like to do your project?

74. When would our lessons fit into your curriculum or schedule?

    1. Jan-Feb
    2. Mar-Apr

    1. May-Jun
    2. Jul-Aug

    1. Sep-Oct
    2. Nov-Dec

    1. Other

76. If you checked "Other", please enter specific dates or comments

78. Are there any resources we should be aware of?

80. Is there anything else we should know?

84. Background Information
    To help us better understand where you and your school or organization are on the sustainability track, please rate the following questions.

    To help us better understand where you and your school or organization are on the sustainability track, please rate the following questions.

86. What level of environmental and sustainability programs are already in place?

    1. There is a culture of recycling and sustainability practices
    2. There are some efforts; a green team, environmental clubs, composting, natural yard care, etc.
    3. There is a little effort towards recycling, lessons or environmental education
    4. None of the above seem to be happening
    5. Unsure

88. What kind of administrative support do you have at your school or organization?

    1. Administration has requested integration of sustainable practices, we have full financial, time and training support
    2. Administration supports and approves of sustainability
    3. Administration lacks understanding but may be willing to support sustainability
    4. Administration is not supportive at all

90. How feasible would it be to get your students or group out into the community for a project?

    1. Unlimited field trip availability, access to nature nearby, funds for trips and chaperones
    2. Moderate field trip time and funds, access to schoolyard or park
    3. Very limited on field trips, funding and other resources
    4. No money at all, no time for a field trip, no chaperones, etc.

92. What, if any, other environmental education have you, your students or your group worked with, experienced or learned from?

    1. None
    2. Pierce County Environmental Educators
    3. Tahoma Audubon
    4. Stream Team
    5. Zoo (Pt. Defiance, Woodland Park)

    1. Harbor Wildwatch
    2. WSU Extension (Master Gardeners, etc.)
    3. Northwest Trek
    4. Camp Arnold or other outdoor school
    5. Other

94. Please list other environmental education not listed above

96. Subscribe to email updates for environmental education?

    1. Yes
    2. No

Leave This Blank:


98. 1. Receive an email copy of this form.
99. Email address

    This field is not part of the form submission.

100. Submit

* indicates a required field