Today's Date:  (example: 01/29/07)

Name (and/or Number) of School: 

Address:     

City:  State:       Zip:   

Phone:       (format: xxx-xxx-xxxx)   ext.    Fax:   Email:

School Contact Person:    Alternate Contact Person:

What month would you like to schedule the advisory:  Undecided Call to discuss January February March April May June July August September October November December    

Who will this advisory be for: Teachers Only Students Only Both Teachers and Students

Please answer the following four questions so we can better understand your needs and situation.

Has your school or organization ever held a Science Fair before?

                        Yes           No     

If yes, approximately when was your last fair?    Last year Year before last 3 years ago Greater than 3 years ago Do not know when the last fair was held

Has ESC ever provided your school with an Advisory?   

                       Yes             No

If you already have a science fair scheduled, what is the date of the fair? 

When you have completed this form please click the submit button below.

THANK YOU!