Schedule a Field Trip

if you would like to schedule a virtual field trip to the MSU Museum, please fill out and submit the request form below. Please give us two potential program dates and times (in EST). If you are not contacted within 1-2 business days after submitting your request form, please contact us at (517) 353-3882 or office@virtualoutreach.org

Program Registration (Pick top two date and time choices.) Program Title * Trip Date 1   (m/d/y) 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 201120122013 Trip Time 1   (h:mm am/pm) 123456789101112 : 0102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AMPM Trip Date 2   (m/d/y) 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 201120122013 Trip Time 2   (h:mm am/pm) 123456789101112 : 0102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 AMPM Teacher Name * Teacher E-mail * Class Grade Number of Students School Name School Address School City, ST  Zip  ,      School County School Phone Number (   )   -   ext  School Fax Number (   )   -    Technical Information IP Address                                        123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255 . 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255 . 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255 . 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254255 Connection Speed 10100 MBps Video-Conference Room Phone Number (   )   -   ext  Technician Name Technician Phone Number (   )   -   ext  Technician E-mail Do you have any special concerns or needs? If yes, please describe.