Mobile Planetarium Request Form

Thank you for your interest in the STEM Center’s Mobile Planetarium! Please complete this questionnaire to better inform us of your plans for the planetarium so we may generate an appropriate quote. A member of our team will reach out to coordinate.

Please make sure to make your request a minimum of 2 weeks ahead of time. This will help our team plan the STEMobile move. However, filling this form does not guarantee that we will be able to accommodate your request.

Please provide the following information about your organization:
Name of School/Organization
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Please provide the following information about the contact person for this visit:
Name Name First Last
Title/Role
Email
Phone Phone - ### - ### ####
Preferred Method of Contact:
Briefly describe the goal or purpose of the visit:
Please list three desirable dates for your visit starting with the most desirable:
/ MM / DD YYYY
/ MM / DD YYYY
/ MM / DD YYYY
How many participants are expected to use the planetarium?
Please estimate how many participants in your group fall within the following age groups:
Pre K-1st
2nd-4th
5th-8th
9th-12
Adults
Are there any special accommodations that need to be made?

We can accommodate wheelchairs, but it is helpful to know ahead to make entry/exit as smooth as possible.

Mobile Planetarium Request Form

Mobile Planetarium Request Form

Please provide the following information about your organization:

Please provide the following information about the contact person for this visit:

Briefly describe the goal or purpose of the visit:

Please list three desirable dates for your visit starting with the most desirable:

How many participants are expected to use the planetarium?

Please estimate how many participants in your group fall within the following age groups:

Are there any special accommodations that need to be made?