STEAM Machine Request Form STEAM Machine Request Name* First Last Email* Phone*Are you the main contact of the event?*YesNoName of Contact* First Last Email* Phone of Contact*Name of Event*STEAM Machine Class Catalog (For large events with over 20 participants, selecting Self-Paced STEAM Kits is highly recommended.)Age demographic of Event*Elementary School (2nd - 5th)Middle School (6th - 8th)High School (9th - 12th)AdultEvent Type for Elementary School*Multiplication & Division By numberAddition & Subtraction By numbersSTEAM JeopardyMathemagicians: 'Geometry'Mathemagicians 'Tallies, Data, and Graphs'Animal Trivia GameTangram Puzzle FunRulers and Measurements - Pentaminos (Indoor)Rulers and Measurements - Catapult (Outdoor)AnimationDigital IllustrationRulers and Measurements - Pentaminoes and Catapult (Indoor/Outdoor)Snap CircuitsCode & Go Robot MouseCode BreakersSelf-Paced STEAM KitsEvent Type for Middle School*Mathemagicians: 'Geometry'Mathemagicians 'Tallies, Data, and Graphs'ProcreateAnimationDigital IllustrationCharacter DesignTie Dye LiteSelf-Paced STEAM KitsEvent Type for High School*Mathemagicians: 'Geometry'Mathemagicians 'Tallies, Data, and Graphs'ProcreateAnimationDigital IllustrationCharacter DesignSelf-Paced STEAM KitsEvent Type for Adults*Computer Skills Lab: Open LabComputer Skills Lab: Basic Computer SkillsComputer Skills Lab: Using the InternetComputer Skills Lab: Setting up an Email AccountComputer Skills Lab: Creating and Saving DocumentsSelf-Paced STEAM KitsAudience Description*STEAM Machine Terms and Conditions Howard County Library System’s new mobile classroom brings science, technology, engineering, arts and mathematics classes to students in grades 2 –12 (and adults), who are unable to participate in STEAM classes at a local HCLS branch. The STEAM Machine is a FREE service. We will work with organizations to meet accessibility needs. Priority is given to students from disconnected and under resourced communities and will be deployed based on HCLS staff and resource availability. Please read and indicate agreement to the following: My event/organization is located within Howard County. The majority of my service population: face barriers in accessing Howard County Public Library’s fixed facilities; are attendees of Title I Schools; or come from under resourced or at-risk populations. Promotional materials for the STEAM Machine will be supplied by the HCLS to use for marketing. My site meets the following physical standards: Has direct in and out access for the 33 ft. long, 13 ft. high, and 10 ft. width of the STEAM Machine, roughly 6 parking spaces across. Must have ample room to maneuver and park. Has no overhead tree branches, powerlines, signage, etc. Restroom access for STEAM Machine staff. HCLS regularly takes event photos for promotional purposes. I will provide "Opt Out" photo waivers for participants who do not want photos taken. I understand the STEAM Machine can accommodate up to 14 students sitting aboard the vehicle per class. I will communicate any requirements for special accommodations or assistance relating to a disability in my request. I understand that both 30- and 60-minute classes require that I provide a minimum of 1 adult to be present to supervise and 2 non-HCLS adults if onboard and outdoor activities are occurring simultaneously. I understand that all class/events require an additional 60 minute set up time, and 60 minute take down time. This time is automatically built into my request. I understand that my participants may be asked to take an anonymous survey. No identifying information will be collected. I understand that HCLS has the right to cancel a STEAM machine visit in the event of inclement weather, unscheduled vehicle maintenance, or other unforeseen circumstances. STEAM Machine staff will notify me of the cancellation as soon as possible. Terms and Conditions* I have read this Agreement carefully and agree to the terms and conditions. Date of Event*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Start Time* : HH MM AM PM Community Organization/School*Address of Event* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ‘Do you want HCLS HiTech to promote this event to the public via our eblast? ’*YesNoCAPTCHA