K-12 Group Visit Request – Emily Dickinson Museum

Group Coordinator Name (first, last) *

Daytime Phone Number *

Coordinator Email *

Cell phone number (day-of visit contact): *

School Name *

School Address (city, state, zip) *

Group Escort (first, last)

(If different than trip coordinator)

Number of Students *

If uncertain, please provide your best estimate.

Number of Chaperones *

Trip leader and paraprofessionals are free. One additional chaperone is permitted free-of-charge for every 10 students.

Student Grade Level *

Preferred Date

Please let us know the preferred date for your visit. Groups of 15 or more are scheduled on Mondays and Tuesdays in school year whenever possible, and on Tuesday in the summer.

Preferred Time *

Additional times can be added in Notes.

How did you hear about group visits to the Emily Dickinson Museum? *

About Your Group/Notes

Please tell us about your group so we can plan the best trip for your students. Are there additional curriculum connections you are hoping to make? Please let us know if you have any accessibility needs or requirements for the booking.

Curriculum Connections *

Writing (poetic form; writing process; literacy)
Science (nature studies; botany; geology)
History & Social Studies (American and local history)
Other (include in notes below)
None

Thank you for your interest in visiting the Emily Dickinson Museum! We look forward to meeting your students.