Today's Date
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School District Name and Number
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School Name
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School Street Address (including city, state, and zipcode)
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Current Principal Name
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Email Address (principal)
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Phone Number (principal)
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How many fifth grade teachers do you have?
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1 2 3 4 5 6 7 8 More than 8
5th Grade Classroom Teacher Names (list all)
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Teacher Email Addresses (list all)
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Teacher Phone Number (Please include extension)
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Primary Point of Contact - Please enter the name and contact information for primary person who will be coordinating details for the visit to STARBASE. (Please provide secondary contact information for being reached during summer months, if needed.)
School Hours for 2025-2026.
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If yes, please list below and explain the recurrence or frequency.
Please list your school hours below. Include the hours for any early release days.
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Please list your major school breaks and days off other than major holidays.
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Please list any specific dates you are not able to attend STARBASE. Please note, this is not a section for preferences. Please only list dates for scheduled events, such as Wolf Ridge (conference nights or other annual field trips), holiday programs, music concerts, etc.
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Student Information - Projections for 2025-2026
Please provide information for your school's 5th grade students.
Projected number of 5th grade classrooms for 2025-2026 school year
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1 2 3 4 5 6 7 8 9+
Approximate class size (per each of the classrooms above)
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Projected Total Number of 5th Graders for the 2025-2026 School Year
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If you answered yes, please list the number of 4th grade students.
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STEM Program Questions
Why do you feel the STARBASE program has been or will be an important part of your 5th grade curriculum? What goals do you have for yourself, your school, your students by participating in the program?
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If you have attended STARBASE for multiple years, what impact do you feel the hands-on, applied math and science curriculum is having on students in higher levels of education and/or those who may be entering the workforce?
What steps is your school taking to increase students' knowledge, skills, and confidence in STEM? How is STEM being incorporated into your existing programming?
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Please provide any other information or comments you would like to share with STARBASE Minnesota, Inc. - Duluth.
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