Field Trip STEAM Scholarship Fund Application

H/Field Trip STEAM Scholarship Fund Application

School/Organization Information
School/Organization Name*
School District*
write N/A if not applicable
County Name*
write N/A if not applicable
School/Organization Address*
Street Address Address Line 2 City State ZIP Code
Contact Name*
First Last
Contact Phone*
Contact Email*
Has your school or organization received scholarship funds in the past?*
- Yes
- No
- Unsure
Please state the year, amount, and use of the funds.*
Student Grade Level(s)*
Science Topics Taught*
Percentage of students eligible for free/reduced lunch in your school*
Percentage of students eligible for PA Child Care Works Subsidy*
For childcare facilities only, write N/A if not applicable
Essay Questions
How will your students benefit from the program? (250 words or less)*
What are your school or organization's goals and how will the program you are requesting support the outcomes you work towards? (250 words or less)*
Describe what is done in your classroom to inspire the exploration, understanding, and appreciation of science, technology, engineering, art, and math (STEAM) in your students.*
How can Da Vinci Science Center support your school or organization's STEAM curriculum and planning efforts?*
Group Visit Request
Type of request (select all that apply)*
- School Field Trip (No Traveling Exhibit)
- School Field Trip + Traveling Exhibit
- Weekend/Summer Group Visit (No Traveling Exhibit)
- Weekend/Summer Group Visit + Traveling Exhibit
School Field Trip (No Traveling Exhibit)*
$13.00 per person
Price:
Total number of adults & students for your School Field Trip (No Traveling Exhibit)*
School Field Trip + Traveling Exhibit*
Price:
$18.00 per person
Total number of adults & students for your School Field Trip + Traveling Exhibit*
Weekend/Summer Group Visit (No Traveling Exhibit)*
Price:
$17.00 per person
Total number of adults & students for your Weekend/Summer Group Visit (No Traveling Exhibit)*
Weekend/Summer Group Visit + Traveling Exhibit*
Price:
$25.00 per person
Total number of adults & students for your Weekend/Summer Group Visit + Traveling Exhibit*
Number of students attending your trip*
Number of adults attending your trip*
Preferred date(s) and arrival/departure time(s) for your trip*
Additional Information
Comments/Questions?
Total
$0.00
By checking this box, you acknowledge that all of the above information is accurate and that the funds will be used as indicated here.*
- Acknowledged
Date*
MM slash DD slash YYYY

Field Trip STEAM Scholarship Fund Application

School/Organization Information

Essay Questions

Group Visit Request

Additional Information

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