Teacher Training Reservation Form

* = Required Fields

School/District Information

* Name of School:		District:
* Address:
* City:	* State/Province:	* County:
* Zip/Postal Code:	* Country:	Would You Like an On-Site Facilitator from our staff?: (Travel Expenses May Apply) Yes No

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	Satellite Rescue: 120 minutes
Fire Scene Investigation: 120 minutes	Target Moon: 120 minutes
Storm-e, New York/Dayton: 60 minutes	M.A.R.S.: 120 minutes
Cyber Surgeons (Pilot Testing - Invite Only): 90 - 120 minutes

Training Mission Information

Preferred e-Mission Schedule: (please provide first two choices below)
* 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:
* 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

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

ISDN:

IP with Video Conferencing Equipment:

IP with Computer & Webcam (Skype):

Other:

If you have any questions, please feel free to contact:

Lori Kudlak
Lead Flight Director
1-304-243-8729
lkudlak@cet.edu

Kathleen Frank
Assistant Director
1-304-243-2495
kfrank@cet.edu

For technical questions and assistance, please contact:
Robert Moore
Technical Coordinator
1-304-243-2063
rmoore@cet.edu