LCCC SIM Mobile Educator Visit / Equipment Loan Request

  1. Please submit this form AT LEAST 2 WEEKS PRIOR to the date requested in order to facilitate scheduling.
  2. ONLY ONE LAB REQUEST PER FORM PLEASE! To submit multiple requests, click the "back to form" button that appears with your confirmation message, change the necessary information and submit again.
  3. Please complete all requested information (items highlighted with a red asterik MUST be completed). Then scroll to the bottom of the form to submit your request.
  4. After clicking the Submit button, a message should appear on your computer screen notifying you that your submission was succesful.  IF YOU ARE RETURNED TO THE REQUEST FORM PAGE, THEN SOME REQUIRED INFORMATION IS MISSING OR INCORRECT, such as entering the wrong date. Please review your answers and supply any needed information, then re-submit.
  5. You will automatically be sent an email showing the details of your successful request.
  6. You will be contacted via email by the LCCC SIM Director at least 1 week in advance to schedule your visit and discuss any logistical details.
  7. Depending upon demand, you may be limited to only 1 request per month in order to allow us to better serve more teachers and their students.
Please provide the best number to contact you in case of last minute emergency (sick, Mobile Educator, bad weather, etc.)
Please list at least one or two alternate back-up dates in case we are not able to visit on your first choice. Also list any other date details here.
Enter the experiment title (and Vernier Lab Book title and Exp #, if available) from the list of SIM experiments found in the Biology, Biotechnology, Chemistry, Environmental Science, Middle School Science, Physics, or Renewable Energy subject folders.
Hour and Minute (am or pm)
Hour and Minute (am or pm)
All teachers must have been trained on the safe and proper use of the equipment and chemicals involved.
*Subjects Taught:

*Grade Level(s):

*AP or Honors Level Courses:

Science in Motion Director
Call/Fax Ph: 610-799-1993