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Education Outreach Request

2. Teacher Name*

3. Teacher Email*

4. Teacher Phone Number

6. Name of School*

7. School District*

9. School Address*

10. City *

12. Grade Level(s)*

13. Subject Taught

15. Number of Classes *

16. Number of Students per Class*

18. Program Options
    The Maricopa County Air Quality Department (MCAQD) has a menu of options to best suit the needs of your classroom. All resources are provided for FREE to educators within Maricopa County.

    The Maricopa County Air Quality Department (MCAQD) has a menu of options to best suit the needs of your classroom. All resources are provided for FREE to educators within Maricopa County.

20. Please select all that apply:*

    1. Online air quality lessons
    2. Virtual guest speaker presentations
    3. Actvities and resource kits for non-formal education programs
    4. Virtual STEAM Events
    5. Other: Please describe in the "Additional Request Information" box

    Please note that in-person guest speaker presentations have been suspended until further notice.

21. Additional Request Information:

23. How did you hear about us?

25. Spanish Resources

    1. Please check this box to request a Spanish speaking staff member.

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field