Request form for teachers

Your contact information

Your name(Required)

First Last

Your position(Required)

Your school(s)(Required)

Your preferred email(Required)

A phone number where you can be reached(Required)

What is the best way to reach you as a teacher to help you get connected to our programs? Select one(Required)

Email that you provided above

Phone # that you provided above

Other (you will be asked to write in a contact method)

Your classroom needs

Please specify...

…the number of individual classes you are requesting our lessons be taught in:(Required)

…the number of students per class:(Required)

…the students’ grade level (please enter only a number here):(Required)

…the name of the class(es) (e.g., Biology):(Required)

In order to choose the program(s) that best fit your needs, please take a moment to click the links below to learn about our three program offerings. Once you have done so, proceed to the field below and select the program or programs that best fit your needs.

Guided Dissection of the Bovine Eye
“In the Dark and In the Light” Comparative Anatomy PowerPoint/Peardeck Lesson
Exploration Station Kits

Which of our outreach programs are you requesting? You may choose more than one option.(Required)

Guided Dissection of the Bovine Eye

“In the Dark and In the Light” Comparative Anatomy PowerPoint/Pear Deck Lesson

Exploration Station Kits

You indicated that you are interested in our Exploration Station kits. Please select the kits that you are interested in using in your classrooms. You may select more than one.

Different Ways of Seeing (What cataracts, glaucoma, and macular degeneration are and their effects on vision.)

Be Wise and Shade Your Eyes (Understand UV light, use UV-detecting beads, & demonstrate how sunglasses protect eyes)

Can You Believe Your Eyes? (Optical and visual illusions)

How We Perceive Color (Nature of color vision; kinds of and tests for color blindness)

Seeing Near and Far (How perspective is accomplished with shading, position and color, and more)

Our goal is to reach as many students as possible, and one way to do this is to train teachers themselves to help deliver our lessons to students. Would you be interested in attending a training session on Cow Eye dissection to prepare you to provide this activity in your classroom?(Required)

Yes, I am interested in attending a training session

No, I am not interested in attending a training session

What time of day can work for this kind of training? You may select more than one.

Immediately after school

Monday early release day

Evening

Scheduling request

Indicate the preferred date(s) and time(s) you would like our team to be on site at your school. The requested date(s) should not fall within the next 30 calendar days, as we will need at least one month’s notice to coordinate a visit.

Please note that while we are excited connect with you and your students, we cannot guarantee that we will be available at your requested times this year. That being said, our volunteers will do their best to accommodate your request and will reach out to see if other dates are a possibility in the event that your initial request cannot be accommodated.

Indicate the preferred date(s) and time(s) you would like our team to be on site at your school. You may add also add any other relevant scheduling information or constraints here.(Required)

Do you have any flexibility with regard to the date(s)/time(s) you specified above, or the time of year that MERI can present to your class(es)?(Required)

Yes

You indicated that you have some scheduling flexibility. Please indicate any alternative dates, times, or times of year that we could visit your school.

MERI educators would like to expand our offerings. Do you have any suggestions for lessons related to eyes or eye health that we should create? If so, please write your suggestion(s) below:

Phone

This field is for validation purposes and should be left unchanged.

Request a lesson at your school

Your contact information

Your classroom needs

Please specify...

In order to choose the program(s) that best fit your needs, please take a moment to click the links below to learn about our three program offerings. Once you have done so, proceed to the field below and select the program or programs that best fit your needs.

Scheduling request