Fill out the following form to request a class visit. Please remember that our visits are only available near our CERSP Universities in NC and TX. If possible, please submit your request at least one month before the proposed visit date.

First Name:                   Last Name:

E-mail Address:        Phone Number:

School Information:

School Name:

Street:

City:         State: GA NC         Zip:

Please provide details about your proposed class visit below.

Date:         Time:

Grade:         Number of Participants:

The visit is to be held at: My School The Science House

Please complete the activities on:

               Carbon Dioxide Polymers Undecided/Other

Comments: