Virtual Field Trip Provider Badge

Complete this form to begin earning your Virtual Field Trip Provider  badge.
 

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Occupation/Role:	(select occupation or role) Business/Community: Business Member Business/Community: Community Member Business/Community: Government Agency Member Business/Community: Other Content Provider: Adminstrator Content Provider: Consultant Content Provider: Curator Content Provider: Educator Content Provider: Independent Provider Content Provider: Other Content Provider: Technician Ed. Service Centers/Consortiums: Curriculum Ed. Service Centers/Consortiums: Director Ed. Service Centers/Consortiums: Other Ed. Service Centers/Consortiums: Technology Ed. State Organization: Curriculum Ed. State Organization: Other Ed. State Organization: Superintendent/Director Ed. State Organization: Technology Education: Administrator Education: Counselor Education: CTE Education: Curriculum Education: Media/Technology Specialist Education: Other Education: Paraprofessional Education: Parent Education: Principal Education: Student Education: Superintendent Education: Teacher Library: Other Library: Patron Library: Staff Retirement Community: Activities Director Retirement Community: Director Retirement Community: Other
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Country:	United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Dem. Republic) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey and Alderney Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Island of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic Republic of) Korea (Republic of) Kuwait Kyrgyz Republic Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua-New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Re union Republic of Dominica Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Time Zone:	(none) (UTC-12.00) International Date Line West (UTC-11.00) Midway Island, Samoa (UTC-10.00) Hawaii (UTC-09.00) Alaska (UTC-08.00) Pacific Time (US & Canada) (UTC-08.00) Tijuana, Baja California (UTC-07.00) Arizona (UTC-07.00) Chihuahua, La Paz, Mazatlan - New (UTC-07.00) Chihuahua, La Paz, Mazatlan - Old (UTC-07.00) Mountain Time (US & Canada) (UTC-06.00) Guadalajara, Mexico City, Monterrey - New (UTC-06.00) Guadalajara, Mexico City, Monterrey - Old (UTC-06.00) Central America (UTC-06.00) Central Time (US & Canada) (UTC-06.00) Saskatchewan (UTC-05.00) Bogota, Lima, Quito (UTC-05.00) Eastern Time (US & Canada) (UTC-05.00) Indiana (East) (UTC-04.00) Georgetown, La Paz, San Juan (UTC-04.00) Manaus (UTC-04.00) Caracas (UTC-04.00) Asuncion (UTC-04.00) Atlantic Time (Canada) (UTC-04.00) Santiago (UTC-03.50) Newfoundland (UTC-03.00) Brasilia (UTC-03.00) Buenos Aires (UTC-03.00) Montevideo (UTC-03.00) Greenland (UTC-02.00) Mid-Atlantic (UTC-01.00) Cape Verde Is. (UTC-01.00) Azores (UTC+00.00) Casablanca, Monrovia, Reykjavik (UTC+00.00) Greenwich Mean Time (UTC) (UTC+00.00) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London (UTC+01.00) Belgrade, Bratislava, Budapest, Ljubljana, Prague (UTC+01.00) Brussels, Copenhagen, Madrid, Paris (UTC+01.00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna (UTC+01.00) Sarajevo, Skopje, Warsaw, Zagreb (UTC+01.00) West Central Africa (UTC+02.00) Windhoek (UTC+02.00) Athens, Bucharest, Istanbul (UTC+02.00) Cairo (UTC+02.00) Amman (UTC+02.00) Beirut (UTC+02.00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius (UTC+02.00) Harare, Pretoria (UTC+02.00) Minsk (UTC+02.00) Kaliningrad (UTC+02.00) Jerusalem (UTC+03.00) Kuwait, Riyadh (UTC+03.00) Moscow, St. Petersburg, Volgograd (UTC+03.00) Nairobi (UTC+03.00) Baghdad (UTC+03.50) Tehran (UTC+04.00) Tbilisi (UTC+04.00) Yerevan (UTC+04.00) Baku (UTC+04.00) Abu Dhabi, Muscat (UTC+04.00) Caucasus Standard Time (UTC+04.00) Izhevsk, Samara (UTC+04.50) Kabul (UTC+05.00) Islamabad, Karachi (UTC+05.00) Ekaterinburg (UTC+05.00) Tashkent (UTC+05.50) Sri Jayawardenepura (UTC+05.50) Chennai, Kolkata, Mumbai, New Delhi (UTC+05.75) Kathmandu (UTC+06.00) Almaty (UTC+06.00) Astana (UTC+06.00) Novosibirsk (UTC+06.50) Yangon (Rangoon) (UTC+07.00) Bangkok, Hanoi, Jakarta (UTC+07.00) Krasnoyarsk (UTC+07.00) Dhaka (UTC+08.00) Irkutsk (UTC+08.00) Kuala Lumpur, Singapore (UTC+08.00) Beijing, Chongqing, Hong Kong, Urumqi (UTC+08.00) Perth (UTC+08.00) Taipei (UTC+08.00) Ulaanbataar (UTC+09.00) Osaka, Sapporo, Tokyo (UTC+09.00) Seoul (UTC+09.00) Yakutsk (UTC+09.50) Adelaide (UTC+09.50) Darwin (UTC+10.00) Brisbane (UTC+10.00) Canberra, Melbourne, Sydney (UTC+10.00) Hobart (UTC+10.00) Guam, Port Moresby (UTC+10.00) Vladivostok, Magadan - New (UTC+10.00) Vladivostok, Magadan - Old (UTC+11.00) Solomon Is., New Caledonia (UTC+11.00) Chokurdakh (UTC+12.00) Anadyr, Petropavlovsk-Kamchatsky (UTC+12.00) Auckland, Wellington (UTC+12.00) Fiji, Marshall Is. (UTC+13.00) Nuku'alofa

I am submitting this form to affirm that I will be completing the work necessary to earn the Virtual Field Trip Provider  badge. 

I understand that my final submission should be sent to CILC within 6 weeks from today.