Distance Learning Program Request

Use this form to book a distance learning program with PPHM. Our education department will contact you shortly.

First Name

Last Name

Email Address

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Teacher Phone Number

School Name

School Address

State

Grade Level

Number of Students

Program Name Dinostaury Time

Week of the Young Child (April 13-15)
Presidents' Day (Jan-Feb only)
Wild and Wacky Weather
Dinomite Dinosaurs
Quanah Parker: Adapting in a World of Change
Home on the Plains: A Bison's Journey
Panhandle Petroleum
A Native American's MVP
The Bedecked Buckaroo
From Boom to Dust
Dia De Los Muertos (Nov only)
Dinostaury Time

Proposed Date of Program

Proposed Time of Program

Your Time Zone

2nd Choice Date

2nd Choice Time

In accordance with T.A.C. Rule �206.74, with few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected by forms.

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2503 4th Avenue Canyon, Texas 79015 806-651-2244