K-12 QCN Sensor Request Form (Printable)

K-12 Contact Information
  Name:     Last:   First:   I:
  Phone:
  E-mail:
  Address 1:
  Address 2:
  City:  State:   Zip: 
  Country:
  Grades Taught?
  Subjects Taught?
  Number of Years Taught?
     
School Information
  School Name:
  School District:
  Address 1:
  Address 2:
  City:  State:   Zip: 
  Country:
  Title I school?:
  Percent free/reduced lunch??:
  Percent English language learners?:
  Percent non-white students?:
     
Processing Fee:
  Number of Sensors:    (3 maximum)  X $5
  Additional Sensors:   X $49
 
   

At the moment QCN does NOT ship internationally, but we hope to in the near future. Sensor shipments start in November, 2008.
     
  Payment

Please print this form and mail a check payable to:

The Quake-Catcher Network
Geophysics Department
Stanford University
397 Panama Mall, Room 360
Stanford, CA 94305
USA