Field Trip STEAM Scholarship Fund Application

"*" indicates required fields

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

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

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*

This field is for validation purposes and should be left unchanged.

Support Us

Your support will help us bring science to life and lives to science in so many ways — including our exhibit experiences, academic and visitor programs, professional development for educators, and our new facility.

Field Trip STEAM Scholarship Fund Application

School/Organization Information

Essay Questions

Group Visit Request

Additional Information

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