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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 60 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:
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 MAF?
Please note: lunch is limited to 30 minutes at the end of your GENESIS school visit and takes place in our outdoor courtyard.
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 PM
2 PM - 5 PM
other
Other Time (1st Choice)
Second Choice
Date
Time (2nd Choice)
10 AM -1 PM
2 PM- 5 PM
other
Other Time (2nd Choice)
Third Choice
Date
Time (3rd Choice)
10 AM -1 PM
2 PM - 5 PM
other
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?
Yes
No
(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.
Yes
No
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
[email protected]
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Contact Information
