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* = Required Fields

School/District Information

* Name of School:
* Address:
* City:
* State/Province:
* County:
* Zip/Postal Code:
* Country:

Would You Like an On-Site Facilitator from our staff?:
(Travel Expenses May Apply)


Time Required for Teacher Training e-Missions
Visit www.e-missions.net for more information

Overview of e-Mission: 15 - 30 minutes Overview + Demonstration: 20 - 60 minutes
Operation Montserrat: 180 minutes Moon, Mars, and Beyond: 120 minutes
Space Station Alpha: 120 minutes
Fire Scene Investigation: 120 minutes Target Moon: 120 minutes
Storm-e, New York/Dayton: 90 minutes M.A.R.S.: 120 minutes
Hurricane Alert!: 120 minutes PanDemSim: 90 minutes- Invitation only
Cyber Surgeons: 15 - 60 minutes e-Labs Overview and Demo: 15 - 60 minutes


Training Mission Information

* Your Name:
* Phone: (XXX-XXX-XXXX)
* Email:
Time Zone:
Good Time to Contact You: (ex: 9:00am - 3:30pm, Mon - Fri)
* e-Mission Choice (See Times Above):
* e-Mission Type:
Complete Teacher Training e-Mission Short e-Mission Overview Overview + Demonstration
# of Teachers/Adults:
Grade Levels Represented:
Preferred e-Mission Schedule: (please provide first two choices below)
* 1st Choice Date: (mm/dd/yyyy)
* Start Time:
* End Time:
* 2nd Choice Date: (mm/dd/yyyy)
* Start Time:
* End Time:
Comments or Essential Requirements


Technical Information

Technology Coordinator:
Office Phone: (XXX-XXX-XXXX)
Cell Phone: (XXX-XXX-XXXX)
Good Time to Contact:


How will you be connecting with the Challenger Learning Center?
(please provide a connection address if you know it)

IP with Video Conferencing Equipment:
IP with Computer & Webcam (Skype):

If you have any questions, please feel free to contact:
Lori Kudlak
Assistant Director
or Laura Ondeck
Lead Flight Director
For technical questions and assistance, please contact:
Dan Murphy
Technical Coordinator

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