Form Center

2. Onslow County Museum
   Outreach Program Suitcase Kit Registration Form
4. Name*
5. School Name*
7. Email Address*
8. Phone Number*
12. Mark the box for the Outreach Program your school would like to request.*

    1. Colonial Lifeways

    1. Native NC
14. Requested Two Week Loan Period*
    Requested Two Week Loan Period
    Please use the calendar option to request a beginning date for when your school would like to use the Outreach Program Suitcase Kit.
15. Backup Date Request*
    Backup Date Request
    Please use the calendar option to provide a secondary date in case your first date is already filled.
17. How would you like to receive the Outreach Program Suitcase Kit?*
    -- Select One --I will pick up the suitcase at the MuseumI would like the suitcase delivered to my school
21. Number of classes using the Kit:*
22. Average number of students per class:*
24. Grade Level:*
25. Would you like an Outreach Program Interview with Mrs. Mary?
    -- Select One --YesNo
27. Outreach Program Interview*
    Outreach Program Interview
    If you would like to schedule an Outreach Program Interview please use the calendar to pick three potential dates.
28. Second choice*
    Second choice
29. Third Choice*
    Third Choice
31. Preferred media platform for Outreach Interview*

    1. Zoom
    2. Teams
    3. Other
32. If Other, please indicate what media platform you would like to use.*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field