Mission Goals/Program Request Forms Feedback
Please complete the downloaded request form if you want to be contacted regarding school visits and  if you want to establish a mutual schedule for a visit with your school.   The request form is shown here only  to illustrate the required information.  Click here to download the form in MS Word format.   Send this completed request form to John H. McCormick, EO Chair by fax 717-534-4632 or USA Mail to 428 Beech Ave, Hershey, Pa.  If you questions prior to sending your completed forms , please call John McCormick, 717-533-6516 (e-mail: jhmccormick2002@yahoo.com) or contact your local CPEWC member.

In addition you can email the request form as an attachment as long as you send it in MS WORD 2000, (or earlier version) format - do not send as MS WORD McIntosh format.   (An alternate contact is Steve Roman at sroman@wbcm.com, or 717-790-9838.)

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After our school visits have been completed, please fill out the FEEDBACK SURVEY FORM to assist us in future school visit programs.

SHADOW PROGRAM:  Please contact Steve Roman, ASHE at 717-790-9838 or sroman@wbcm.com for high school students.  Refer to question #20 in the REQUEST FORM .

CAREER DAY PROGRAM:  Please contact John McCormick at 717-533-6516 or jhmccormick2002@yahoo.com.  You may contact your local CPEWC member on this request form.  Refer to question #21 in the REQUEST FORM .

 

REQUEST FORM

1. Date: _______________________________________________

2. Teacher Name:__________________________________________

3. Teacher Telephone Number:_______________________________

4. Teacher E-Mail Address:_________________________________

5. Best time to contact Teacher by phone at School?_____________

6. School Name and Address__________________________________

________________________________________________________

7. School District Name:__________________________________

8. County:______________________________________________

9. School Levels: Elementary, Middle, or High School?

10. What grade level for this request? 5th, 6th,,7th, 8th, or Junior?

11. Science or Mathematics subject ?

12. Number of Students in classroom ?

13. Do you have any preference for Engineering Field? Yes or No? If yes, what Engineering Society do you prefer. We can’t always guarantee a volunteer speaker from a specific engineering field for our school visit

14. What is the current topic in your mathematics or science course work which our EO volunteer should be aware of prior to his or her school visit?

15. Please provide name, phone number, and e-mail address in School Administration Staff for us to contact if we can’t reach you during school session ?

 

16. Does your school have any policy on camera photography and token gifts for your students? If so, please explain.

17.  Will this school visit request include additional classrooms? If so, please confirm classroom information on #1 thru #15 for additional classrooms and teachers.

18.  What is your school classroom schedule request for EOC school visit ? Can we work on a mutual advantage schedule together?

19. Would you be willing to complete a FEEDBACK SURVEY FORM which is attached on another Web page?

20. For SHADOW request, can we contact your Staff or Career Guidance Counselor for information on your student and his/ her request ?

21. For CAREER DAY request,can you provide copy of your program and student information ( grades,class size ?) to our Staff.

 

Educational Outreach Committee takes this opportunity to express our desire to assist your classroom in explaining the importance of Mathematics and Science subject as it relates to Engineering Field.

Thank you for your time and support.

John H.McCormick EO Chair
717-533-6516(p), 717-534-4632(fax), jhmccormick2002@yahoo.com,
428 Beech Ave Hershey, Pa 17033

Alternate EOC contact personnel is Steve Roman, ASHE 717-790-9838(p) or sroman@wbcm.com .