Learning Lab Reservation Request Form

Visit Details:

* Number of Groups:

One group for one two-hour lab experienceRequired

Two groups from the same school

* Date of Visit:

Required 1st Choice of Date

Required 2nd Choice of Date

(Reminder: Labs are available Tuesdays – Thursdays)

* Lab Time:

10am - 12pm (Arrival 9:50 am)Required

12:30 pm - 2:30 pm (Arrival 12:20 pm)

Both (Two groups in rotation from the same school from 9:50 am to 2:30 pm)

Section 2: Contact Information

* Teacher's Name:

Required* First Name

Middle Initial

Required* Last Name

Suffix

* Job Title:

Required

* Email:

Required Please use standard email format

* Confirm email:

Required The addresses do not match

* Phone:

10 digits with no punctuation Required

* Cell Phone:

10 digits with no punctuation (Required for Day of Visit) Required

FAX:

10 digits with no punctuation

Section 3: School Information

* School/Workplace Name:

School Name Required

* Address:

Street Address Line 1 Required

Street Address Line 2

* City:

Required

* State:

Required

* Postal/Zip Code:

Required

Section 4: Group Information

* Number of Students:

Number of Students Required (between 12 - 72) Please enter number of students as digits between 12 - 72 No more than 72 students total (2 groups of 36) Minimum of 12 students

* Number of Teachers:

Required

* Number of Other Chaperones:

(We ask that there be 1 chaperone for every 10 students) Required

* Grade Level:

Required

* Type of Class:

(U.S. History, Civics, Language Arts, etc.) Required

Special Needs Accommodations:

Section 5: Applicant Agreement

National Archives and Records Administration

Learning Lab Request Agreement

There is no guarantee requested dates or times will be available. Once your request has been received, you will be contacted with a confirmation or additional information.

I have read and agree to the terms of the Pre-visit Preparation and Requirements, and my students will be prepared for their visit. I understand I may bring no more than 36 students per lab session.Required

Visits to the Rotunda and other exhibition areas are not part of the lab experience. I must allow more time if I want my students to visit these spaces.Required

Constitution-in-Action Lab Registration Form