Online Request Form for Class Visits and Activities

To book your Faculty of Mathematics and Science class visit and activity at Brock University, please complete and submit the form below.

School: *

Enter the name of your school

Grade: *

Enter the grade of your class

Number of students: *

Enter the number of students participating

Activity Location: *

At Brock University

In your classroom

Subjects currently available: *

Chemistry

Computer Science

Mathematics

Date and Time: *

Insert at least 2 suggested dates and times when you would like to arrange your activity. NOTE: we require at least 2 weeks notice.

Workshop Selection: *

Please indicate which activity you are interested in by providing the title of the workshop.

About you

Name: *

Title: *

Preferred Contact Method: *

Phone

Email: *

Best time to reach you : *

Please indicate the best time to reach you at the number provided

Home Phone:

Work Phone: *

Cell Phone:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Brock University Niagara Region 500 Glenridge Ave., St. Catharines, Ont., L2S 3A1 Canada

Telephone: 905-688-5550