PLC Request Form_Experiences

Thank you for your interest in Poudre Learning Center (PLC) programming! If you would like to schedule an educational program for your classroom or organization, please complete this form. Our team will review your request and contact you to confirm the scheduling details.

Please visit PLC.greeleyschools.org/educators for more information or contact plc_education@greeleyschools.org with questions.
Contact Information
Lead Contact Name*
Email*
Phone Number*
Please enter a valid phone number.
If more than one educator is involved, please list their name(s) and email(s):
School or Organization Name*
Check this box if you are a public, non-charter school within Greeley-Evans School District 6.
School or Organization Address*

Street Address

CityState / Province

Postal / Zip Code
Name of school Office Manager or Administrative Assistant*
Office Manager email*
Office Manager phone*
Please enter a valid phone number.
Participant Information
Total number of students*
NOTE: If applicable, this number will be used to calculate billing totals, regardless of actual attendance.
Number of classes*
Grade level or age range*
Enter class subject if HS
How many students with disabilities will be present?*
Ex. Mobility differences, neurodivergence, etc.
Please state ways we can accommodate your students and adults to support their experience. The more information provided, the better we can differentiate our programming to serve them!*
How many CLD students will be present?*
Will you have an interpreter for your CLD student(s)?*

YesNoOther
Please list which languages are represented by your CLD students, if any.
Program Request

School year: Tuesday - Friday only. Summer: Monday - Thursday only. Please select a date no sooner than 2 weeks from today to allow for proper planning and resource availability.
Are your students participating in Caring for Our Watersheds (grades 8-12)?*

YesNoNo, but I'd like more information
Location Request*

School ClassroomPoudre Learning CenterOther
First Choice*

MonthDayYear
To select Mondays during the summer, write the date in "Additional Scheduling Comments"
Second Choice*

MonthDayYear
To select Mondays during the summer, write the date in "Additional Scheduling Comments"
Arrival Time*

Hour Minutes

AM/PM Option
Departure Time*

Hour Minutes

AM/PM Option
Additional scheduling comments:
Click here to view our lesson offerings.
After viewing the lesson guide (linked above), please list lessons you would like included in the program. NOTE: A half-day program can do 1-2 lessons, a full day can do 3-4. *
Does each classroom have access to a working sink?*

YesNoOther
Will our team have access to a classroom projector?*

YesNoOther
What do you hope to achieve by the end of the experience?*
Cost & Scholarship Application

All programming is FREE for public, non-charter schools in District 6. For all other groups, we charge a fee of $25/student. Financial assistance may be available through our scholarship program.
Should my program be confirmed, I understand the program cost will be calculated based on the number of students provided above, rather than the number of students who attend.*

Yes
I am applying for a transportation scholarship ($300) to help with the cost of busing.*

YesNo
I am applying for a tuition scholarship to help with the cost of program fees.*

YesNo
Amount you are requesting for program fees*
Is your school a Title I school?*

YesNo
Please explain other factors that may contribute to your need to cover program fees or transportation.*
How did you RECENTLY hear about the Poudre Learning Center?*

ReferralSocial MediaSearch Engine (Google, Bing, etc.)Previous PLC programEmailDistrict 6 IntercomOther
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Contact Information

Participant Information

Program Request

Cost & Scholarship Application