17901 Bentley Road
Sandy Spring, MD 20860
301-774-0022 Fax 301-774-8149
www.sandyspringmuseum.org
Today's Date ___________
School or Group ______________________________ Phone _______________
School Address ____________________________________________________
Email Contact ______________________________ Grade Level ____________
Person completing form _________________________ Position _____________
Staff Development contact person ______________________________________
Number of Students ____________ Number of Classes _________________
Number of staff and chaperones _______________________________________
Number of days requested ___________________________________________
Day and month requested:
1st choice _____________________
2nd choice ____________________
3rd choice ____________________
Museum contact: Kathy Polletto or Meg Leeds, Education Department
kpolletto@sandyspringmuseum.org mleeds@sandyspringmuseum.org
The Sandy Spring Museum is supported in part by funding from the Arts and Humanities Council of Montgomery County.