DATE REQUEST FORM

You must agree to the following statements to proceed with submission.

Office managers are required to complete registration. If you haven’t already, please review your GAE Training Guide.
You can register at any time during your designated sign up period. Requests will not be approved until the sign up period has ended. You will be notified via email of the decision within 1 month after registration closes.
The office manager is required to attend both school and community visits. If the office manager is unable to attend all visit days, the office manager is responsible for finding a replacement.
The GAE visit fee is $250 a day. A 50% deposit must be made before visit day, and the final amount will be due the last day of the visit.
Due to our supportive sponsors, subsidies are available for eligible organizations or schools to help cover the visit cost. The subsidy program is needs-based. Please contact your district manager for subsidy requests.

Terms Acknowledgement:

I have read and agree to the terms above.

County Farm Bureau Details

COUNTY OFFICE INFORMATION

Please list the details for the county Georgia Farm Bureau office that is submitting this date request.

County FB Office Name

County Office Address

Office Phone Number

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County

District

FB COUNTY COORDINATOR - MAIN CONTACT

The GAE main contact for the County Farm Bureau is typically the Office Manager. NOT A SCHOOL/ORG CONTACT

If the office manager is unable to attend, they are responsible for finding a replacement.

Full Name (FB County Coordinator)

Position

Cell Phone Number

Did you submit the training quiz? Y/N

I understand and agree:*

The Office Manager is required to assist in setting up and taking down the Georgia Ag Experience mobile classroom and particpating during the event. If unavailable, the Office Manager is required to find a replacemnent volunteer.

Event Details

ORGANIZATION / SCHOOL INFORMATION

Request Type

School Visit
Community Event

Organization Type

Elementary School
Community Organization
Other

Name of Organization/School

Address (Organization/School)

If approved, the trailer classroom MUST be parked on a flat, paved, level surface (no grass/dirt). Access to the event location must be large enough for a tractor trailer to easily enter and the exit the parking area. Will this be possible at the event location?

Has the Georgia Ag Experience visited your COUNTY in the past 3 years?

Does the school/organization primarily work with low-income individuals?

Does your county have a local farm or other organization that would like to bring livestock/animals to your school or organizational event?

Yes
No
Maybe-Will determine at a later date.

ORGANIZATION / SCHOOL MAIN CONTACT

This will be the main contact for event details (like schedules, registration forms, additional activities) and the contact for delivery of the vehicle.

Full Name (Org/School Main Contact)

Position

Cell Phone Number

Phone Number

Programming, Date Requests & Fees

PARTICIPANT DETAILS

Classroom Style: The mobile classroom is best suited for a classroom setup with no more than 30 students at a time participating in 50 to 60-minute class rotations. With no more than 5 classes per day. *Includes Group Lesson and Career Bingo outside station. This is used for traditional school visits, 3rd-5th grade only.
Ag Event: There is a scheduled rotation of classes or groups throughout the day. This is best suited for Ag days and other similar events at schools. The mobile classroom is a featured activity provided for 3rd-5th grade only.
Open House: The mobile classroom is the featured activity with no additional activities provided; this is best suited for a self-guided, relaxed environment. Open house is best suited for families and visitors at community events, where children are accompanied by adults. All ages welcome.

FEE CALCULATION

Number of Days Needed

*We typically only have 5 classes per day. The number of days listed above is an estimate based on this calculation. If you have 6 classes, please contact us in advance to see if we can make this work. [email protected]

Estimated Fee:

$0.00

ORG NAME/PARTY TO BE LISTED ON INVOICE

*Must list an organization name - not an individuals name.

I understand and agree:*

The Georgia Ag Experience visit fee is $250 a day. The final fee will be calculated once the request dates are approved. A 50% deposit must be made within 14 days.

DATE PREFERENCES

Please review the available dates for your district here. Submissions not within the correct time frame will not be reviewed.

While the Georgia Ag Experience aims to make every attempt for successful visits, we cannot guarantee the delivery of the trailer and staff at every visit. Due to the nature of a traveling trailer, maintenance, weather, and other unforeseen circumstances, cancellations may take place. We reserve the right to change this policy at any given time, of which you will be promptly updated.

Date Preference #1

Date(s) #1 - START DATE

Date(s) #1 - END DATE

*Do not list any duplicate dates. We need 3 different sets of dates.

Date Preference #2

Date(s) #2 - START DATE

Date(s) #2 - END DATE

*Do not list any duplicate dates. We need 3 different sets of dates.

Date Preference #3

Date(s) #3 - START DATE

Date(s) #3 - END DATE

*Do not list any duplicate dates. We need 3 different sets of dates.

Are the above dates flexible?

Additional Notes

If you would like to upload a scanned version of your date request worksheet, please do so here.

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*Please allow 5 minute or more to upload documents.

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