School Visit Request Form School Visit Request Form GENESIS is a STEAM education non-profit. Accurate information about the demographics that we serve is essential to our grant writing and reporting. Please provide as much information as possible. Class Information Number of Students (maximum 50 students) Number of Teachers/Chaperones (minimum 1 adult for every 15 students) Grade (GENESIS at MAF is designed for grades K-12) Number of students that receive free or reduced price lunch: If any students or educators require special accommodations please list them below: Have your students had any experience with coding/programming prior to their visit to MAF?:Please select... Yes No Is your class planning on eating their lunches at Harold A. Henry Park? Please note: This will be an additional stop before heading back to your school and may add an extra 30 minutes to your visit.Please select... Yes No Programs:Please select... Gateway Field Trip Gateway Virtual Field Trip Professional Development Session When would you like to visit? GENESIS at MAF offers 6 session each week on Wednesday - Friday, 1 morning and 1 afternoon each day. First Choice Date Time (1st Choice)10 AM -1 PM2 PM - 5 PMother Other Time (1st Choice) Second Choice Date Time (2nd Choice)10 AM -1 PM2 PM- 5 PMother Other Time (2nd Choice) Third Choice Date Time (3rd Choice)10 AM -1 PM2 PM - 5 PMother Other Time (3rd Choice) Visit Length GENESIS at MAF recommends a 3 hour visit, but we're happy to accommodate your schedule. Groups larger than 30 should plan for a 2 hour visit minimum. How long would your visit be?Please select... 1.5 hours 2 hours 2.5 hours 3 hours School Information & Bus Scholarship Application School Name Is this a LAUSD Title I school? YesNo(Currently, only LAUSD Title I schools are eligible to apply for bus scholarships. Thanks for your understanding!) Would you like to apply for a bus scholarship? Please note there are a limited number of bus scholarships and it is not guaranteed for every school that applies. You will be notified of whether your school received a scholarship when your visit is confirmed.YesNo If your school receives a bus scholarship, how would you like to book your bus?Option 1: Reimbursement (preferred method). Whoever is coordinating the trip must submit an invoice with supporting documentation to MAF (ie the invoice which the school paid) and MAF will reimburse the school.Option 2: Direct Reservation. If there’s no way to book your own bus, then MAF will book one through a charter bus company. Direct Reservation Information Pick up location Desired pick up time Desired departure time Onsite Contact Phone Number Onsite Contact Name Your Information Contact First Name Contact Last Name Contact Email Phone Number School Address Line 1 School Address Line 2 City State Postal Code genesis@marcianoartfoundation.org reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
