Webform Test Page

Full Name:

Email:

Phone Number:

Name of School:

School's Phone Number:

Address:

(Must be a school address. Please do not use a P.O. Box.)

City:

State:

ZIP Code:

Country:

Kit Choice:

Please note that only one kit can be borrowed at a time, with the exception of accessory kits such as Compound Microscopes, Stereo Microscopes, or the Pipette Practice Kit. Accessory kits are meant to accompany other kits and are not lab activities by themselves.

Number of Kits: /

Total number of students using the kits: /

Number of underrepresented minorities students: /

To ensure future NSF funding to support the Lending Library, we are asking all teachers to provide classroom demographic information. Please provide us with an approximate tally of the number of underrepresented minorities (African Americans, Latinx/Hispanic, Native Americans...) and female students in all of the classes where kit materials will be used.

Number of female students: /

Date (always a Monday) you want the equipment:

Generally, you may reserve equipment for a one-week period, beginning on a Monday and ending on Friday. The kits will be delivered to you so that they arrive before your requested use date.

Shipment Notes

If you need to keep this kit for longer than one week, or if you need to receive it at a specific date before the selected week, please fill out this field to let us know.

Check all items you already have and DON'T need shipped:

Multimeters

LabPro/LabQuest

Power Supplies

By checking this box, I certify I have received training for the equipment requested.