Apply for a Scholarship—School Groups

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(s) of Visit

Please suggest one or more dates when you could bring your group. We will work with you to identify a date that we can accommodate.

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

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

Guided tours without an art-making activity are $10/student, and programs that include an art-making activity are priced at $15/student. Please note that if this is a multi-visit program there is a charge for each day.

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.

How many youths with your group are Burlington residents?

How many adults with your group are Burlington residents?

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: