Teacher Request Form

PIE Contact Information

                   Address: One South Church Street Suite 303, Hazleton, PA. 18201
                    Phone: (570) 450-314                  Fax: (570) 454-7787
                   E-Mail: edufirst@ptd.net             Website: www.partnersined.org

Contact Information

Name :
Address:
City:
State:    Zip:     
Phone #:    Fax #: 
Email:

Services Requested

Teacher Tours In Industry Student Tours In Industry
Summer Employment For Teachers  Student Apprenticeships
Share Equipment / Technology Student Co-op Education Program
Participate In Integrated Projects Guest Speaker In Classroom
Student Mentoring Other:

 

Description of Activity:
Grade:
Location:
Date:       
Start Time:          
End Time: