Outreach Request Form 2024-25

Outreach Request Form 2024-25 | Knox

This form is a request for Muse Knoxville to bring programming to your classroom for the 2023-2024 school year. Please contact us at outreach@themuseknoxville.org with any questions.

"*" indicates required fields

Contact Information

Contact Name*

First Last

Contact Email*

School Information

School Name*

County Where School is Located*

School Address*

Street Address City State ZIP Code

School System*

School Phone Number*

Is this a Title I School?

Yes

Group Information

Number of Classes Per Grade Level

Example: 3 - 2nd grade classes

Number of Students Per Class

The maximum number per class is PreK - 20, K-2nd - 25, 3rd-5th - 30. An Outreach Educator will not teach a lesson if the class size exceeds the maximum number allowed.

Grade level that applies*

Multiple grade levels may not be selected. Please submit one form per grade level.

PreK Program | 3-5 year olds*

3, 2, 1, Blast Off!

Ramps, Slides, and Pathways

Shake, Rattle, and Roll

Kindergarten Program*

Animals: Families & Homes

Empathy Explorers

Wonderful Weather

Fairy Tale Engineering

1st Grade Program*

Empathy Explorers

Fairy Tale Engineering

Make Some Waves: Light

Star Gazers

2nd Grade Program*

Animal Adaptations

Make Some Waves: Sound

STEM Structures

Colorful Coding With Sphero indi

3rd Grade Program*

Circling Circuits

Magnificent Magnets

STEM Structures

Colorful Coding With Sphero indi

4th Grade Program*

Full of Energy

Colorful Coding With Sphero indi

Make Some Waves: Light & Sound

STEM Structures

5th Grade Program*

Heredity & Traits

Solid, Liquid, Gas

Spectacular Space

STEM Structures

Changes to Scholarship Availability for 2024-2025

Please read the scholarship changes: For the 2023-2024 school year scholarship funding is extremely limited for Title 1 Schools only. Scholarships will cover ONLY 2 program events per grade level (i.e. 1 Outreach Lesson and 1 Field Trip OR 2 Outreach Lessons.) Application for a scholarship does not guarantee a scholarship will be awarded. Scholarships are awarded in the order they are received.

Check the box to show that you have read and understand the scholarship changes for the 2024-2025 school year.*

I Understand

Program Date & Times Requests

Date Requests: May include specific dates, date ranges and/or preferred months

Time Requests: Must include at least 2 program time slots if there is more than 1 class per grade level (programs last 55 minutes)

Date / Month*

MM slash DD slash YYYY

Program Times*

If you have 2 classes you must provide 2 time slots. If you have 3 classes you must provide 3 times slots.

Do you want to request a second program?

Yes

Grade level that applies for the Second Program Request*

Multiple grade levels may not be selected. Please submit one form per grade level.

PreK Program | 3-5 year olds

3, 2, 1, Blast Off!

Ramps, Slides, and Pathways

Shake, Rattle, and Roll

Kindergarten Program

Animals: Families & Homes

Empathy Explorers

Wonderful Weather

Fairy Tale Engineering

1st Grade Program

Fairy Tale Engineering

Make Some Waves: Light

Star Gazers

Empathy Explorers

2nd Grade Program

Animal Adaptations

Make Some Waves: Sound

STEM Structures

Colorful Coding With Sphero indi

3rd Grade Program

Colorful Coding With Sphero indi

Circling Circuits

Magnificent Magnets

STEM Structures

4th Grade Program

Full of Energy

Colorful Coding With Sphero indi

Make Some Waves: Light & Sound

STEM Structures

5th Grade Program

Heredity & Traits

Solid, Liquid, Gas

Spectacular Space

STEM Structures

Second Program Date & Times Requests

Second Program Date(s) / Month*

Second Program Times

If you have 2 classes you must provide 2 time slots. If you have 3 classes you must provide 3 times slots.

Other Requested Information

What is your lunch time?*

Other helpful information you wish to provide.*

Once your program is completed, you are highly encouraged to compete the follow-up survey provided to you by your Outreach Educator.*

Please select the box below to show you understand.

Yes, I Understand

Scholarship Information

MUSE FOR ALL SCHOLARSHIP GUIDELINES:

For the 2023-2024 school year scholarship funding is extremely limited for Title 1 Schools only.
Scholarships will cover ONLY 2 program events per grade level (i.e. 1 Outreach Lesson and 1 Field Trip OR 2 Outreach Lessons.)
Application for a scholarship does not guarantee a scholarship will be awarded.
Scholarships are awarded in the order they are received.
Please complete the application below to apply.
Allow up to 1 week for the processing of your application.

Do you wish to apply for a Muse For All Scholarship?*

Yes

Scholarship Application

Are you a Title 1 School?*

Yes

Has your school received a grant-funded or scholarship-funded program from Muse Knoxville within the 12 months prior to your requested program date?*

Yes

Unsure

Describe why you wish to provide Muse Knoxville programming for your students, and why scholarship funds are important for your school.*

Terms & Conditions

All information provided is accurate and complies with the form's directions. Once programs have been scheduled with Muse Knoxville's Outreach Manager, unforeseen circumstances do not guarantee rescheduled programs.

Yes, I have read and agree to the Terms and Conditions*

Yes, I have read and agree to the Terms and Conditions

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