Rangersinthe ClassroomProgramRequest

Pleaseprovidethe followinginformationto requestaclassroomprogram.

1. ContactInformation

Lead Teacher

E-mailPhone

School Name

Address

CityPhone

2. RequestProgramsandDates:

Program (Grades,Months) / Date-1stChoice / Date-2nd Choice / Date-3rdChoice
Up,Up,and Away (K-2)Oct,Nov,Jan
BearEssentials (1-4)Feb-April
Meet YourNationalParks(2-4)Oct-April
How to Read aSkullLikeanOpen Book (3-5)Jan-April
Lifeinthe Zone (3-4)Oct,Nov,Jan
Explore YourWatershed(3-5)Jan-April
Guess Hoo's forDinner (4-5)Oct,Nov,Jan
Letters from the Landscape (6-7)Jan-April
Discover YourChanging Climate (6-8)Jan-April
Prerequisites:Lifeinthe ZoneANDWatershed
S.P.R.O.U.T.S.(6-8)Oct-AprilSession A:
(2-part program)Session B:
Prerequisites:Lifeinthe ZoneANDWatershed AND
DiscoverYourChanging Climate

3. Pleasetellus abouttheclasses(maximumof30 studentsper class)wewillbevisiting.

Use onelineper class. Formorethan4classes, use asecondrequestform.

TimeGradeRoom #TeacherName#ofStudents

4. ClassroomNotes

•Does your classroomhaveafunctioningprojectorthatwe may use?

•Doyou haveacomputerwithPowerPointsoftwarethatwe may use?

YesNo

YesNo

•Willthepresenterhaveafull hour?YesNoIf"no,"howmuchtime?minutes

ForPark Use:

InCalendar

InDatabaseNotes:

Email Confirmation

Email 2weeksout

E-mailyour savedform to:

orfaxto: 559-565-3730

PrivacyActStatement

Authority:Theauthoritytocollectinformationontheattachedformisderivedfrom16U.S.C.5966,CommercialUseAuthorizations. Purpose:Thepurposesofthesystemare(1)toassistNPSemployeesinmanagingtheNationalParkServiceCommercialServicesprogramallowingcommercialuseswithinaunitoftheNationalParkSystemtoensurethatbusinessactivitiesareconductedinamannerthatcomplieswithFederallawsandregulations;(2)tomonitorresourcesthatareormaybeaffectedbytheauthorizedcommercialuseswithinaunitoftheNationalParkSystem;(3)totrackapplicantsandholdersofcommercialuseauthorizations whoareplanningtoconductorareconductingbusinesswithinunitsoftheNationalParkSystem;and(4)toprovidetothepublicthedescriptionandcontactinformationforbusinessesthatprovideservicesinnationalparks.

RoutineUses:Inadditiontothosedisclosuresgenerallypermittedunder5U.S.C.552a(b) ofthePrivacyAct,recordsorinformationcontainedinthissystemmaybedisclosedoutsidetheNationalParkServiceasaroutineusepursuantto5U.S.C.552a(b)(3)tootherFederal,State,territorial,local,

tribal,orforeignagenciesandotherauthorizedorganizations andindividualsbasedonanauthorizedroutineusewhenthedisclosureiscompatiblewiththepurposeforwhichtherecordswerecompiledasdescribedunderthesystemofrecordsnoticeforthissystem.

Disclosure:Providingyourinformationisvoluntary,however,failuretoprovidetherequestedinformationmayimpedetheprocessingofyourcommercialuseauthorization application.

PaperworkReductionActStatement

InaccordancewiththePaperworkReductionAct(44U.S.C.3501),pleasenotethefollowing.ThisinformationcollectionisauthorizedbyTheConcessionManagement Improvement Actof1998(54U.S.C.101911).YourresponseisrequiredtoobtainorretainabenefitintheformofaCommercialUseAuthorization. Wewillusetheinformationyousubmittoevaluateyourimpacttoparkresourcesandcompliancewithparkregulationsandlimitations.WemaynotconductorsponsorandyouarenotrequiredtorespondtoacollectionofinformationunlessitdisplaysacurrentlyvalidOfficeofManagement andBudgetcontrolnumber.

EstimatedBurdenStatement

Weestimatethatitwilltakeapproximately 1.25hourstoprepareareport,includingtimetoreviewinstructions,gatherandmaintaindata,andcompleteandreviewthereport.Sendcommentsregardingthisburdenestimateoranyotheraspectofthiscollectionofinformation,includingsuggestionsforreducingthisburden,totheInformationCollectionOfficer,NationalParkService,12201SunriseValleyDrive,MS-­‐242Rm.2C114,Reston,VA20192.Pleasedonotsubmityourformtothisaddress,butrathertotheaddressatthetopoftheform.