Science for the Disadvantaged Application
Name of School*
Principal*
Address*
City, State, Zip*
Contact Person*
Title*
Phone Number*
Email*
Interested in a scholarship for a Field Trip or Edgerton On The Move Program?*
  Field Trip
Edgerton on the Move
Program Date Choice #1*
Program Date Choice #2*
Program Date Choice #3*
Number of Students*
Percentage of Students who qualify for the Free and Reduced Lunch Program*
Best way to contact you* Email
Phone
Best time to contact you*
* Scholarships are limited and will be awarded on a first come, first served basis. Preference will be given to programs scheduled October-February.
Confirmation Code:
Enter the code shown in the box before clicking on submit.

Note: Fields marked by an asterisk (*) are required.

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