Space Grant Application Form
Illinois
Name
*
First Name
Last Name
Email
*
Organization Name
*
Organization Type
*
K-12 School
College/University
Homeschool
Educational Club (i.e. 4-H)
Other
Role
*
Teacher
Administrator
Student
Club Leader
Other
Age Requirement
*
I certify that I am at least 18 years old.
If you selected K-12 School, please choose:
Elementary School
Middle School
High School
If you selected K-12 School, please choose:
Title I School
Not a Title I School
Shipping Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Project Type
*
Moon
Mars
Number of Simulant Packs
*
Max: 5 (1 pack per 10 students recommended)
Number of Participants
*
Approximate if unknown
Age Range of Participants
*
Approximate if unknown
Past Participation
*
I have applied for Space Grant funding in the past and have not be awarded.
I have applied for Space Grant funding in the past and have been awarded.
I have never applied for Space Grant funding.
Why do you want to receive Space Grant funding? Please explain how this funding will help you engage your students in STEM.
*
100 to 200 words
0/200
ERROR: The address you entered does not match the state Space Grant Consortium you are applying to. Please enter a different address or find the correct application at www.plantthemoon.com/register-now.
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