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 of Students*
    -- Select One --PreschoolK-23-56-89-12Other

13. For Other, Please Describe

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.

    The Maricopa County Air Quality Department (MCAQD) has a menu of options to best suit the needs of your classroom.

20. OPTION 1: MCAQD offers award winning air quality curriculum. The curriculum contains lessons aligned to current Arizona Academic Standards. MCAQD provides FREE resource kits delivered right to the classroom with all the materials needed to teach the lessons.

    OPTION 1: MCAQD offers award winning air quality curriculum. The curriculum contains lessons aligned to current Arizona Academic Standards. MCAQD provides FREE resource kits delivered right to the classroom with all the materials needed to teach the lessons.

21. OPTION 2: MCAQD offers FREE guest speaker presentations in the classroom. Students will learn about air quality through an engaging hands-on investigation.

    OPTION 2: MCAQD offers FREE guest speaker presentations in the classroom. Students will learn about air quality through an engaging hands-on investigation.

23. 

24. 

26. Option Selection*
    -- Select One --Option 1: CurriculumOption 2: Guest Speaker PresentationOption 3: Both Curriculum and Guest Speaker Presentation

    Please select which option you are interested in learning more about implementing in your classroom.

28. How did you hear about us?

30. Spanish Resources

    1. Please check this box to request a Spanish speaking staff member attend the guest speaker presentation.

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field