COSI - Columbus, Ohio's Dynamic Hands-On Science Center

Program Type* --Please Select-- COSI On Wheels Preschool COSI On Wheels Toddler Outreach Science Spot Special Events

Has Your School Hosted a COSI On Wheels Program Previously?* --Please Select-- Yes No

If yes, which program did you host?

Program Choice #1* --Please Select-- Incredible Human Machine Current Conditions - Weather Program Investigating Energy It's Simply Chemistry Launch Into Space What's Wild?

Program Choice #2* --Please Select-- Incredible Human Machine Current Conditions - Weather Program Investigating Energy It's Simply Chemistry Launch Into Space What's Wild?

Number of Days Requested?
                                                                    500 student capacity per day

Number of Participants?
                                                                    Total for all requested days

School Year* --Please Select-- 2010-2011

Time of Year*
                                                                    Season, month, etc

Impossible Days?*
                                                                    Breaks during school year, etc

Preference you would like to be scheduled by?* --Please Select-- Date Availability Program Availability No Preference

Desired Topic* --Please Select-- Preschool Let's Get Movin' Preschool Cycle of Seasons Preschool Animal Tales

Number of Sessions*
                                                                    $120 for first session, $75 for additional same-day, same-topic sessions

1st Desired Topic* --Please Select-- Preschool Let's Get Movin' Preschool Cycle of Seasons Preschool Animal Tales

2nd Desired Topic* --Please Select-- Preschool Let's Get Movin' Preschool Cycle of Seasons Preschool Animal Tales

Number of Sessions:* --Please Select-- 2
                                                                    $240 for 2 sessions done per day.

Number of Students per Session* --Please Select-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
                                                                    (20 Student Maximum per Session)

Age Level of Students*

Desired Topic* --Please Select-- Frogs My Hands Space

Number of Sessions* --Please Select-- 1 2 3 4
                                                                    $100 for first session, $75 for additional same-day, same-topic sessions

1st Desired Topic* --Please Select-- Frogs My Hands Space

2nd Desired Topic* --Please Select-- Frogs My Hands Space

Number of Sessions* --Please Select-- 2
                                                                    $200 for 2 sessions done per day.

Number of Students per Session*
                                                                    (15 Student Maximum per Session)

Age levels of students:*

Number of Kiosks (COSI will select a random mix based on the number chosen)* --Please Select-- 5 10 15 20

Dates:*

Number of Participants per Date:*

Desired Time Frame:*
to

Have you hosted a COSI Science Demo previously?* --Please Select-- Yes No

If yes, which program?:

Program Choice #1* --Please Select-- Incredible Human Machine Current Conditions Investigating Energy It's Simply Chemistry Launch Into Space What's Wild?

Program Choice #2* --Please Select-- Incredible Human Machine Current Conditions Investigating Energy It's Simply Chemistry Launch Into Space What's Wild?

Number of days requested?*:

Estimated attendance?*:

Date(s) desired?*:

Program Type?* --Please Select-- Demo Only $350.00 Demo + Partial Hands-On Demo + Full Hands-On

Name of School/Event*

School Phone*

Address 1*

Address 2*

City*

County*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code*

Contact Name*

Position or Title*

Primary Phone*

Alternate Phone*
                                                                    After hours, non-school number for contact person

Email*

Address 1*

Address 2*

City*

State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code*

Important Terms & Conditions are available by clicking here. By clicking "Submit Request," you agree to these terms and conditions.