NASA Education Outreach Volunteer Request

The KSC Education Outreach Program provides teachers within a 50-mile radius of KSC with the tools to reach and inspire their students. The program seeks to capture young people’s interest in science, engineering, mathematics and technology. Over 200 KSC employees volunteer to share their knowledge and experience with teachers and students annually. Volunteers participate in various outreach opportunities including career speakers, performing hands-on activities in the classroom, career interviews and judging at science fairs. KSC also strongly supports the National Engineers Week and National Space Day. Requests for volunteer services must be made 4 to 6 weeks in advance.

If your group is larger than one classroom (approx 30-35 kids), please contact the KSC Speakers Bureau at: http://www.nasa.gov/centers/kennedy/about/speakers-index.html

Note: Fields with the red star are required fields
To (Name & address of NASA installation)
  NASA, John F. Kennedy Space Center, XA-D
  Attn: Helen Kane
  (Phone:321.867.4444 Fax:321.867.2097)
  (Email: Helen.P.Kane@nasa.gov)
From (Name and Address of School)
Name *
Address *
City * Zip
State
County *
EVENT Name or Title *
Date of Event
(MM/DD/YYYY)		 * Time of Event
Begin * End *

Location		 (Name & address of hall, auditorium, etc., room, tel. no., if any)
*
Choose an Education Outreach Program *
SPEECH Topic Desired *
Question/Answer Period * Q/A Time Allowed (if YES)
EQUIPMENT (As available) Description
Screen Lectern
Light Pointer
Qualified Projectionist
 Slide Projector (2 x 2 inches)
Public Address System
Lavaliere or Lapel Microphone
 Slide Projector (3 1/2 x 4 inches)
Room can be Darkened for Films, Etc.
Motion Picture Projector (16mm with optical sound)
AUDIENCE
Anticipated Size 		* Grade(s) *
Composition (Teachers, students, general public, family, etc.)
   *
  
EXCLUSIONS  Is, or will any person, for reason of race, color, sex, religion, or national origin, be excluded from or segregated within membership in sponsoring organization, attendance at event or any of the facilities housing this
event? * Yes (if Yes, please explain in Remarks) No
Speech to be Taped, Filmed, or Otherwise Recorded (if YES, briefly explain below) *
If Yes, explain
Has a NASA Volunteer previously visited your classroom? *
If Yes, please indicate name of volunteer
REMARKS
Furnish information about your class(es) that you would like to share with the volunteer; i.e., special student populations, bilingual students, space-related topics you plan to study, etc.
Contact Name * Tel. *
Email    
Please carefully review your information before you submit