SEM Classroom Presentation Request Form
Edmonton and Area, 2013-2014
Please complete and return your request to SEM Coordinator Gary Berge gberge@ualberta.ca
Main Contact Information
First name: _____________________ Last name: __________________________ Position: ________________
School/Institution: ___________________________________________________________________________
Address: ___________________________________________________________________________________
Phone: ________________________________ Email: ______________________________________________
Booking Information
The SEM program is currently accepting bookings for presentations at Edmonton and area schools on
Mondays, and Tuesdays beginning September, 2013 and ending June, 2014. Preference will be given to
schools that can organize multiple class presentations during the school visit due to the extensive setup/take-down time required for the microscope. To accommodate multiple classes, the presenter will
need to set up in a separate room (booked for the entire day – 9am to 3pm) where each class can visit for
a 1 hour interactive presentation. In order to allow for maximum student interaction, please do not
combine classes beyond a max capacity of 35 students.
The following breakdown can be used as an example of how the visit might occur: set-up from 8-9am,
class presentations from 9am -3pm, take-down from 3-3:30 pm. Specific details for the visit to your school
will be arranged with the presenter once the booking date is confirmed.
Request Information
Number of Presentations Requested (limit 4 per day): _____
Presentation 1 - Grade: _____, Course: ________________, # of students: _____ Teacher: ________________
Presentation 2 - Grade: _____, Course: ________________, # of students: _____ Teacher: ________________
Presentation 3 - Grade: _____, Course: ________________, # of students: _____ Teacher: ________________
Presentation 4 - Grade: _____, Course: ________________, # of students: _____ Teacher: ________________
Please select your preferred date for the visit to your school. We will do our best to accommodate every request,
however, once these dates are full, we will be unable to accept additional bookings for the 2013-2014 schedule.
Remaining dates available
October
November
December
2
January
6
Feburary
3
March
3
April
7
May
5
June
2
3
7
4
8
6
3
11
9
12
10
10
10
14
12
9
11
11
15
13
10
17
17
21
19
21
22
28
18
18
22
20
24
24
29
26
25
25
30
27
29
Once the request is submitted, you will be contacted by Gary Berge to confirm a date for the school visit.
1-2 weeks prior to the school visit, Gary will contact you again to confirm details of the visit.