Teacher Request

Please complete the form below

If request is for more than one class, please complete one form for each individual teacher.

School Name

School Principal's Name

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Title 1 School

Check only one box

YES, we are a Title 1 school

NO, we are NOT a Title 1 school

Teacher Name

First Name

Last Name

Teacher Email

Teacher Phone

(###)

###

####

Has the teacher completed the Community Water Safety class provided by M-DCPS?

YES

Class Grade Level

Class Student Count

How many of these students have passed the Red Cross Level 3 swim test?

This is required by M-DCPS for students to take part in a water-based field trip.

Virtual Program (Lessons 1&2) Day/Time Preference

PROGRAM DESCRIPTION Lessons 1 & 2: Marine Ecology & Biology (45 min each, virtual presentation via Zoom) Lesson 3: Floating Classroom (3 hour program on Biscayne Bay - teacher must be Water Safety Certified and students must receive M-DCPS swim test) Lesson 4: Ocean Hero Challenge (45 min, student presentation in school) Check all that apply

MONDAY AM

TUESDAY AM

WEDNESDAY AM

THURSDAY AM