DATE REQUEST FORM

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

If you haven’t already, please review your GAE Training Guide and complete your GAE Training Quiz before registering your school or organization.
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.
We recommend at least 1-2 additional county volunteers to support the county coordinator during the visit. Online training is suggested for volunteers prior to the visit, but not required.
The GAE visit fee is $250 a day. A 50% deposit must be made before visit day, and the final amount will be due day of 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 and invite-only. Upon approval of your date request, you will be notified if your organization or school is awarded the subsidy.
You and your visit location must be willing to allocate at least 50 minutes per student for the Georgia Ag Experience. (No short 15 min etc. The trailer activities are planned and take some time.)

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

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

Full Name (FB County Coordinator)

Position

Cell Phone Number

Did you submit the training quiz? Y/N

Training assessment must be submitted by the main contact. If not, please complete before.

ADDITIONAL VOLUNTEER #1 (REQUIRED)

At least one volunteer, in addition to the main contact/county OM, must be present at every day of the event and arrive early to help set up. A visit will not be approved if a volunteer cannot be present. DO NOT LIST THE MAIN CONTACT AGAIN HERE.

Full Name (Volunteer #1)

Cell Phone Number

ADDITIONAL VOLUNTEER #2 (OPTIONAL)

Name (Volunteer #2)

Cell Phone Number

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?

Has the Georgia Ag Experience visited your SCHOOL/ORGANIZATION in the past 3 years?

Does the school/organization have any AG programming in place already?

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

ORGANIZATION / SCHOOL LEADERSHIP CONTACT

Approval of the event is required prior to submission. Please list the contact info for an individual of the organization's leadership who has approved this visit request (i.e. School Principal, Organization Executive Director, District Manager, etc.)

Full Name (Org/School Leadership Contact)

Position

Phone Number

Programming, Date Requests & Fees

PARTICIPANT DETAILS

Fair Style: The mobile classroom is one of many other vendor activities at the event. This is best suited for Ag days and other similar events.
Open House: The mobile classroom is the featured activity with no additional activities provided; this is best suited for a self guided, relaxed environment. *Laminated copies of the scavenger hunt are available for you upon request.
Classroom Style: The mobile classroom is best suited for a classroom set up with no more than 30 students at a time participating in a 50 to 60 min class rotation. *Includes Group Lesson and Career Bingo outside station.

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

NAME/PARTY TO BE LISTED ON INVOICE

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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