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Kentucky Proud

Welcome to the Division of Agriculture Education, Farm Safety and Farmland Preservation

                                                                                                                                                                                      

MOBILE ACTIVITY CENTER REQUEST FORM
                              Teacher Name:
                   example: Mr. JohnDoe
School Name:
example: First Elementary School
School Address:
example: 123 Street, Frankfort KY
School Phone:
example: (502) 564-4696
School Fax:
example: (502) 564-4696
Grade Taught:
example: 2nd
County:
example: Franklin
Home Phone:
example: (502) 564-4696
Email Address:
example: John Doe@Franklin.kyschools.us
# of Classrooms to use Activity Center:
example: 4
List 3 Potential Dates for Orientation:
example: 6/13/2002
Lisit 3 Potential Dates for School Visit:
example: 6/13/2002

Cost is $100 per day for a maximum of three days per school. Make checks payable to KAEC. 

 
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