Submit a request to Praxis Science and Technology Network
Complete this form to submit a request to the Praxis Science & Technology Network - Medicine Hat
**Required Information

**Your Name, First:

  

**School/Organization:

**Your Name, Last:

  

Teacher:

School Board:

 

**Email:

**Phone Number :

 

**City:

**Address:
Please Note: We cannot guarantee times or dates but will do our best to accommodate your requests.
Enter Date in the following format: DD/MM/YYYY

**Start Date:

  

**End Date:

**Start Time:

 

**End Time:
 

Number of Presentations:

Number of Classes:

Number of Students/Participants:

Grade Level:

Event:

**Topic:

Comments about the request (special considerations?)

  

Description of the request
 
**

I understand that a teacher must be present at all times during a scientist visit, and in charge of classroom management. I will supply feedback to PRAXIS promptly.