Apply for a Scholarship—See Think Do

Name of school/community group

Number of students in group

Teacher/Program Coordinator

Address

City/Town

State/Province

ZIP/Postal Code

Phone

Email Address

Date of Program Visit(s)

Date of Program Visit(s)
	Date of Program Visit(s)	Item weight

more items

What do you hope your students/institution will gain from participating in this program?

Program fee is $10/student. Please note that if this is a multi-visit program, each day is $10/student (ex: a two visit program would be $20/student total).

Scholarship Amount Requested

Are you able to contribute toward the fee? (If yes, list amount)

Please share what you can about your group! We are committed to creating a diverse and inclusive organization, and this information helps us achieve this goal. All responses are confidential. Choose all that apply to the group.

Age

0-5

6-10

11-13

14-17

18-24

25-44

45-64

65+

Other…

Gender

Female

Male

Non-Binary

Self-Identified:

Distinct Groups (check all that apply)

Veteran or Active Duty Personnel

English Language Learner

Living with a Disability

Living below the Poverty Line

Living in non-traditional housing (such as a hospital, assisted care facility, homeless shelter or other transitional housing facility)

None of the above

Self-Identified:

Race/Ethnicity (Select all that apply)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Prefer not to say

Self-Identified: