Zooquarium Scholarship Application

Apply Here

for your ZooQuarium program scholarship.

School
School Name*
First Last
School District*
School Address*
Street Address Address Line 2 City State ZIP Code
Percentage of Free/Reduced Lunch Students*
Schools with 60% of students receiving free or reduced lunches are eligible to receive these scholarship funds.
Primary Contact
Name*
First Last
Primary contact teacher must be responsible for all Zoo communication.
Phone*
School Email*
Program Information
Grade Levels*
Number of Students Participating*
Up to 30 students may participate per program session.
Number of Program Sessions Requested*
- 1
- 2
- 3
- 4
Total Scholarship Value*
($75/session)
Requested Program Dates*
(These must be at least 10 days from the date you submit this form.)
Requested Topics*
(You may select multiple.)
Describe Benefit*
Please describe how participation in this program will benefit your students and support their learning.
Any other questions/information?
Electronic signature*
I, the undersigned primary contact teacher, understand and meet the requirements of this scholarship on behalf of the school and classes applying. I understand that my name typed here represents my full legal signature.
Date*
Date Format: MM slash DD slash YYYY
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