GGA Order Form - Pennsylvania Society for Biomedical Research

Great Grow Along Rat Order Form

This form is for teachers in the PA, DE, and WV area who would like to use the Great Grow Along in their classroom. ALL participants must follow the approved 4 week feeding schedule. The feeding schedule may not be altered in any way.

Name*

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Email Address*

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Confirm Email Address*

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School*

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School Mailing Address, City, State, Zip*

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Cell Phone Number (xxx-xxx-xxxx). In case it is needed for rat pick up communication*

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Grade Taught*

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Subject Taught*

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Approximate # of Students Participating*

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# of rats needed (min. of 2 rats per classroom)*

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Do you need rat cages?*

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Do you need rat water/milk bowls?*

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Do you need rat food bowls?*

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Do you need bedding for the cages? (PSBR will provide bedding for up to 4 rats per classroom)

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Do you need a teacher's curriculum manual? (Available in digital format)*

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Do you need plastic rat tunnels? (This is a form of enrichment for the rats to hide, play, and sleep)*

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Where would you like to pick up the rats?*

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NOTE: The rats MUST be picked up on the chosen pick up date. The rats may NOT be left at the facility overnight. Please plan accordingly.

What date would you like to pick up the rats? Please see the week day associated with each location above. *

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How did you learn about the Great Grow Along Project?*

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Have you used this program in the past?*

YES

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Does your above request include rats or supplies for another teacher or co-worker?*

YES

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If you clicked 'YES' for the previous question, please provide the other teacher's information including school, email, and number of students participating in each class.

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Will you be able to adopt out your rats or keep them as a classroom pet? (Note: Animals may NOT be set free outside, taken to an animal rescue, or returned to PSBR or the breeder).*

YES

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NOTE: Deviating from or altering any part of the 4 week feeding schedule can result in harm to the rats due to calorie or nutritional deficiencies. Using the rats for anything other than the approved 4 week feeding schedule as written by PSBR is strictly prohibited.

I confirm that I will follow the rat feeding schedule and curriculum as written by PSBR. (Using the rats for anything other than the approved feeding schedule is strictly prohibited). *

YES

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Percent of students that identify as: male, female, non-binary, or other

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Percent of students that identify as: White, Black, Hispanic or Latino, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or Other

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Percent of students classified as Title 1

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Any Additional Comments/Questions?

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