Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Teacher *

First Name

Last Name

Name of Trip Coordinator

(if different than teacher)

First Name

Last Name

Phone *

(###)

###

####

Mackinac State Historic Park site(s) to be visited

Please check all that apply

Colonial Michilimackinac (Mackinaw City)

Old Mackinac Point Lighthouse (Mackinaw City)

Historic Mill Creek (Mackinaw City)

Fort Mackinac (Mackinac Island)

Richard and Jane Manoogian Mackinac Art Museum (Mackinac Island)

Immersive program participating in

Please check all that apply

Military Muster at Fort Mackinac (evening program)

An Evening with the Voyageurs at Colonial Michilimackinac (evening program)

History Nights at Colonial Michilimackinac (overnight program)

Has your school received an in-person education outreach program from Mackinac State Historic Parks?

Yes

No

Has your school participated in a Mackinac State Historic Parks virtual education outreach program?

Yes

No

Has your school ever visited Mackinac State Historic Parks?

Yes

No

Has your school ever received a Mackinac Associates grant to visit Mackinac State Historic Parks?

Yes

No

Authorized Official *

First Name

Last Name