Distance Learning Program Request Form

Please fill out the form below if you are interested in a distance learning program for your class. Please note that these programs are meant for classes/groups, not for individual sign ups.

The time and date you put on this form does not reflect our availability. After we receive your request, we will reach out with a link to our calendar so that you can book a date and time for your program and a test call. 

If you have questions, you can email us at [e-mail].

Programs are typically about one hour long. You can find out more about each program here: Ranger-led Distance Learning - Glacier National Park (U.S. National Park Service) (nps.gov). Please review the program offerings and identify which program is the best fit for your class.  

NPS Form 10-1750 (Rev. 04/2021)
National Park Service

OMB Control No. 1024-0228
Expiration Date 11/30/2025

Learning Accommodations

Does anyone in your group need any accommodations?

Yes No

If yes, describe the accommodation need.

Next Step

School / Organization Contact Information

School / Organization Name (required)

Name of Requester/Contact Person (required)

Title / Position (required)

Contact Email Address (required)

Contact Phone Number (required)
123-456-7890 extension if any

Contact Mailing Address Country

I have a US mailing address

I have a mailing address outside the US

International Mailing Address (required)
Please include building number and street, city, state/province country and Postal Code

Mailing Address (required)

City (required)

State (required)

Alabama Alaska American Samoa Arizona Arkansas Armed Forces - Americas Armed Forces - Europe Armed Forces - Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming

ZIP (required)
Five digit ZIP code [99999]

Next Step

Group Details - Virtual / Distance Learning Program

Name of Primary Contact if Different Than Above (optional)

Title / Position of Primary Contact if Different Than Above (optional)

Email Address of Primary Contact if Different Than Above (optional)

Phone Number of Primary Contact if Different Than Above (optional)
Format: 123-456-7890

Program Name or Subject Requested

Grade Level(s) of Students (required)

Number of Attendees / Students (required)

Preferred Date of Program (required)
format mmddyyyy

My preferred date has been confirmed by the park.

Yes No

Alternative Date(s) (required)
Enter one or more dates.

Preferred Program Start Time (required)

Time Zone of the Classroom (required)

How much time will the ranger have to conduct the program? (required)

Discussion Points for Virtual / Distance Learning Program

Virtual and/or Distance Learning can vary depending on the technical capabilities of the park and the school. in order to find appropriate accommodations for your learning experience, here are some categories to be prepared to discuss with the park:

1. Internet Access
2. Phone Access (speaker phone or conference line)
3. Mobile or digital video conferencing capabilities
4. Firewall
5. Hardware and Software Capabilities
6. Classroom pre-work or assignments

Disclaimer:

A park representative will follow-up to confirm group details once this request has been received and reviewed.

Submit my Education Reservation Request

---

NPS Form 10-1750 (Rev. 04/2021)
National Park Service

OMB Control No. 1024-0228
Expiration Date 11/31/2025

Notices

Privacy Act Statement

Authority: Public Law 114-289 National Park Service Centennial Act and 54 U.S.C. 100701 Protection, interpretation, and research in System.

Purpose: To administer education programs for education audiences including but not limited to school groups, scouting groups, extracurricular groups, and home school groups.

Routine Uses: To effectively manage requests for education received by the NPS, the Education Reservation Request Form is used to collect basic education reservation information to facilitate operational aspects of scheduling groups for park education programs, including in-park education programs, ranger in classroom programs, and/or online distance learning programs.

Disclosure: Voluntary, however, failure to provide the requested information may impede the ability to grant your education reservation request.

Paperwork Reduction Act Statement

We are collecting this information subject to the Paperwork Reduction Act (44 U.S.C. 3501) to provide park managers and educators the information needed to schedule and conduct education program activities. All applicable parts of the form must be completed in order for your request to be considered. You are not required to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned control number 1024-0288.

Estimated Burden Statement

Public reporting for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive, Fort Collins, CO 80525. Do not send your completed form to this address.