Home > Group Programs Booking Form Request Groups Programs Groups Programs Request Group Programs Information Request Please tell us about yourself Reservation and Billing Contact * Reservation and Billing Contact First Name First Name Last Name Last Name Email * Mobile Phone * Is this contact person also the group leader who will be with the group during this program? * Yes No Please tell us who the group leader will be. Please tell us who the group leader will be. First Name First Name Last Name Last Name Email Mobile Phone Please tell us about your organization Organization Name * Organization Address * Organization Address Street Address Street Address Address Line 2 Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Group Type Please select a general description of you group.Public schoolPreschoolPrivate schoolHomeschoolCommunity organizationSenior centerCollege/universityOther Is this a Title I school? Yes No School District (if applicable) Grade Level * Kindergarten Pre-K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Adult Are you interested in applying for financial aid? Yes No Amount of Financial Aid Requested Percent Free and Reduced Lunch Please tell us which OMSI experiences you’d like. * Field Trip at OMSI! Traveling Education Program (at your school) Outdoor Science School Museum Overnight Submarine Overnight Family Science Night at OMSI Great! What would you like to do on your field trip? Museum Admission Museum Admission + Featured Exhibit Planetarium Show Movie in the Empirical Theater Submarine Tour Reserved Lab Program Assembly Science Playground (Pre-K Only) Other Will you need to reserve space in the lunchroom? Yes No How will you arrive at the museum? School/charter busCars/vansTrimet Bus/MaxPortland StreetcarOther # of Buses Will the traveling education program take place at your organizations address? Yes No Is the location more than 40 miles from OMSI? Yes No Travel fees will apply What is the address for program? What is the address for program? Street Address Street Address Address Line 2 Address Line 2 City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal What traveling education program(s) are you interested in? Which Outdoor School site are you interested in? Hancock Field Station – Fossil, OR Coastal Discovery Center – Newport, OR Program Length 3 days/2 nights Is Your Group Applying for Outdoor School For All Funding? YesNoUnsure Can you tell us why you’re not applying for this funding? Organization does not qualify I don’t know about the funding The student grade does not qualify Other Please tell us which date(s) you would like. First Choice * Second Choice * Third Choice Earliest possible start time * 8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM Latest possible departure time * 8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM Number of Students * Number of Teachers * Number of Chaperones * Our goal is to provide a safe and inclusive program for all of your students. Do any of your students have physical, mental, or emotional conditions that we can help support during the program? Anything else you want us to know? Captcha Submit If you are human, leave this field blank.