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2. Disclaimer
   Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
4. Hiwan Homestead Museum - School Program Request
   Keeping the stories of the past relevant to our lives today is one of the roles of our staff and volunteers. Check out offerings, including programs at the museum, field trips and presentations at schools (using historic images and artifacts) for students K-12.
6. Use the form on this page to register for the program of your choice.
8. To help ensure your program reservation, please submit your request as early as nine months prior, but no less than 2 weeks in advance. Education programs at Hiwan Homestead Museum are funded by the Jefferson County Historical Society (JCHS). All revenues go to JCHS and not Jefferson County Open Space. Cost: $2 per student (chaperones are free).
12. Choose a Program?*

    1. 4th Grade - Colorado History
    2. 3rd Grade - Arts of the Tribal Southwest
    3. 2nd Grade - Here's History (Outreach - we come to you!)
14. Age of Participants*

    Please check all that apply.

    1. 2nd Grade
    2. 3rd Grade
    3. 4th Grade
    4. 5th Grade
    5. 6th Grade
    6. Other
16. If other, please specify
18. Total Number of Students*
    (minimum group size: 25; maximum group size: 60)
20. Choose a Date and Time
22. Preferred Date and Time (1st choice)
    Preferred Date and Time (1st choice)

    Preferred Date and Time (1st choice)
23. Preferred Date and Time (2nd choice)
    Preferred Date and Time (2nd choice)

    Preferred Date and Time (2nd choice)
25. Any Additional Information
27. How would you like to be contacted?*

    1. Phone
    2. Email
29. First Name
30. Last Name
32. School or Organization Name
34. Contact Phone Number
36. Email Address
37. Please Verify Your Email Address
39. Address
41. Address Line 2
43. City
44. State
45. Zip Code
46. Country
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field