Wonder Fund Field Trip Application

School/Program Name*

Date*

School District

Title I School*

Yes No

Grade/Age*

Contact Person*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Email*

Phone*

The following information is necessary to make a determination of Wonder Fund eligibility. Information given should be about the specific group/class of students who will be experiencing a museum outreach program.

Percent African-American*

Percent Asian*

Percent Caucasian*

Percentage Hispanic*

Percent Native American*

Percent Other (please specify)*

Total number of students in your group/class:*

What percentage of your group/class qualifies for reduced/free lunch?*

Number of adults participating:*

Required: 1 adult for every 5 children

Type of Field Trip*

Exploration Adventure

Please see our website for more details.

In order of preference, list THREE weekday dates/times (including month) for your field trip:*

Please list all possible dates and arrival times for your group's field trip. Exploration Field Trips last 90 minutes and can be booked on mornings or afternoons. Adventure Field Trips last 60 minutes and are only available on mornings during the school calendar year.

Would you like to request an additional 30 minutes for lunch?

Yes No

Signature of Applicant*

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Use your mouse or finger to draw your signature above

Date*

Signature of Principal

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Use your mouse or finger to draw your signature above

Date