STE(A)M Truck Client Inquiry Form STE(A)M Truck Client Inquiry Form We thank you for your interest in partnering with STE(A)M Truck! Please fill out the form below so we can better understand your needs and help design a program that meets your goals. Contact Information Question Title * 1. Organization/School: Question Title * 2. Role/Title: Question Title * 3. Email Address: Question Title * 4. Phone Number: Question Title * 5. Preferred Contact Method: Email Phone Question Title * 6. About Your Organization School Community Organization Corporate Partner Other (please specify) Question Title * 7. Name of Your Organization Question Title * 8. Briefly Describe Your Organization’s Mission or Focus: (Example: We serve middle school students from underserved communities and focus on experiential learning and STE(A)M education.) Question Title * 9. Are You Familiar with STE(A)M Truck’s Services? If yes, how did you hear about us? Yes (Social Media, Community Event, Networking Event, Word of Mouth, Online Search, Local News) Somewhat No How did you hear about us? Question Title * 10. Program Interest:Which STE(A)M Truck Service(s) Are You Interested In? Please select the service(s) you’re interested in or choose “Not Sure” if you’d like guidance.) Professional Learning for Educators: (Hands-on workshops to equip educators with maker-centered teaching strategies) Youth STE(A)M Programming: (In-school or after-school hands-on programs focused on STE(A)M skills) Maker Cart and Makerspace Buildouts: (Creating portable or permanent spaces for hands-on learning) Custom Workshops and Events: (Tailored programs for family nights, corporate events, or special STE(A)M initiatives) Not Sure – I’d like to discuss options based on my goals. Question Title * 11. Describe the type of STE(A)M Experience You’re Looking to Create: (Example: A 12-week program focusing on design and innovation for high school students) Question Title * 12. Program Goals and AudienceWho is the Primary Audience for This Program? Elementary Students Middle School Students High School Students Educators/Teachers What Are Your Main Goals for This Program?(Example: Increase engagement in STE(A)M subjects, provide hands-on learning experiences, or support teachers in integrating STE(A)M into their curriculum.) Other (please specify): Question Title * 13. Number of Participants Expected(Estimate the number of students, educators or other participants.) Question Title * 14. What are your main goals of this program? (Example: Increase engagement in STE(A)M subjects, provide hands-on learning experiences, or support teachers in integrating STE(A)M into their curriculum.) Question Title * 15. Timeline and Budget Date / Time Date Time AM/PM - AM PM Question Title * 16. Do You have Budget in Mind for this Program? Yes, please specify below. No. I’d like to discuss options within different budget ranges What is your budget? Question Title * 17. Additional Details:Are There Any Specific Tools, Skills, or Topics You Want to Include? (Example: 3D printing, robotics, coding, design thinking, etc.) Question Title * 18. Is there anything else you would like us to know? (Example: Logistical details, special requirements, or specific outcomes you’d like to achieve.) Question Title * 19. Next StepsHow Soon Would You Like to Hear Back from Us? (We aim to respond within 3-5 business days.) Within 1-2 days Within the week No rush, just gathering information Question Title * 20. Opt-In for UpdatesI would like to receive occasional updates on STE(A)M Truck programs, events, and opportunities. Yes No Thank you! We look forward to learning more about your goals and exploring ways to bring STEAM learning to life in your community. Our team will review your inquiry and follow up soon to discuss the next steps. Done
