Rivers Are Alive Program Info Request Please complete this form to reserve a Rivers Are Alive program for your school. If you have any questions, please contact us. Educator Name* First Last School Name* School Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone (for day of communication)*Email* Enter Email Confirm Email Have you done a Rivers Are Alive program with us before?* Yes No In What Year?* Number of Students* Number of Teachers* Number of Chaperones* Where would you like to hold your Rivers Are Alive field trip?*Please indicate where you would like for your Rivers Are Alive program to take place. Examples are at your school, at the National Park Service Visitor Center, or a local or state park. Grade Level* Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Adult Learner Preferred Date(s)Please share when you would like to hold your program. This could be a specific date, date range, or month or day of the week that would work best for you. Preferred Start and End Time* Do you have a preferred program(s)? (e.g. Let’s Go Mucking, Let’s Go Snowshoeing, Meet a Mussel, etc.) To learn more about our programs, see our Teacher’s Guide.What accommodations do you need to support students with special needs?How will this field trip meet your curriculum goals?How did you hear about Rivers Are Alive?*National Park Service websiteNational Park Service social mediaWild Rivers Conservancy websiteWild Rivers Conservancy social mediaRivers Are Alive brochureMy school has been participating in this programFrom another educator/word of mouthSelect an option.Do we have permission to take photos of your students for promotional material?* All my students have permission to be photographed. Some of my students have permission to be photographed, but not all. None of my students have permission to be photographed. School DemographicsOptional, but completing this section helps to keep Rivers Are Alive programs free and is useful for grant applications.School Title One Status Free and Reduced Lunch Percentage Signature*PhoneThis field is for validation purposes and should be left unchanged.