DISCOVER SCIENCE ASSISTANCE FUND APPLICATION

These scholarships are made possible by the generosity of many friends of the Ann Arbor Hands-On Museum.

Please complete this form and click the Submit button below. We will contact you by email or phone within 5 business days with the status of your request. Or if you prefer you can download a printable form to send by mail or fax.

( "*" Indicates Required Fields)

School Information

*School Name District

*Street

*City *State *Zip

*Percentage of Students Receiving Free/Reduced Lunches:

*Is this a Title 1 School?Yes No

Field Trip Information

*Name of Teacher/Contact

*Phone *Email

Preferred Date of Visit

Second Choice

Student Grade Level

Number of Students Number of Teachers/Chaperones

*Brief statement of why you need assistance:

*Have you previously received assistance from us? Yes No

If so, when? (month/year)

*Have you visited us on a field trip in the last 2 years? Yes No

When was your last visit (month/year)?

( "*" Indicates Required Fields)

(Or click here for a printable form to send by mail or fax.)

CAN'T COME TO US?

We'll come to you with our Outreach program