Wufoo

Name: * First Last
KSC Email: *

PLEASE NOTE: Double check your email address as this is how we will communicate with you.
Please enter TODAY'S date: * MM / DD / YYYY
We need this to make sure we repond to your request in a timely manner - THANK YOU!
Name of your class: *
Class Code: *
Best phone/cell number to contact you: ### - ### - ####
Expected number of students: *
Building and room number where your class will be held: *
Preferred Class Date: * MM / DD / YYYY
If you have more than one class that you would like GEO to visit, complete a form for each class.
GEO Arrival Time on Preferred Date - (GEO prefers not to schedule visits between noon and 1 p.m. if possible.): * HH : MM : SS AM/PM
Alternate Class Date: * MM / DD / YYYY
Please note: these alternate date and time options are to expedite scheduling when we are unable to commit to your first choice.
GEO Arrival Time for Alternate Date - (GEO prefers not to schedule visits between noon and 1 p.m. if possible.): * HH : MM : SS AM/PM
Please note: these alternate date and time options are to expedite scheduling when we are unable to commit to your first choice.
Do Not Fill This Out