KSS Group Program Financial Aid Applicaiton

Group Program Financial Aid Application
At Keystone Science School, we feel strongly about the power and importance of experiential science education. Keystone Science School (KSS) offers financial assistance to offset the cost of our programs to eligible schools. While no funding is guaranteed, we strive to provide assistance to schools with limited resources in order to ensure that youth from a variety of backgrounds and circumstances have the opportunity to attend our life-changing programs.
Basic Information
Name*

First NameLast Name
Phone Number*
E-mail *
Where the confirmation will be send to
Will you be the lead teacher?*

YesNo
Lead Teacher*

First NameLast Name
Lead Teacher Email*
example@example.com
School/Organization Information
School/Organization Name*
School District (if applicable)
School/Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of school/organization:*

PublicPrivateCharterIndependentOther
If you selected "other" above, please explain

School/Organization Ethnicity Percentage*

	Percentage
Native American/ Alaska Native
Asian/ Asian American
Black/African American
Hispanic/LatinX
Native Hawaiian or Other Pacific Islander
White
Multiracial
Prefer not to answer

To Be Filled Out By CX:
Percentage of students receiving free/reduced lunch:
Total Number of Students at School
Student to Teacher Ratio
Average Standard Test Score
Program Information
Preferred Program Season*

Fall (August - November)Winter (December - February)Spring (March - May)
Preferred Dates and Pertinent Notes:
What is the length of program are you interested in?

Day Program2-days and 1-night (1-24 hr periods)3-days and 2-nights (2-24 hr periods)4-days and 3-nights (3-24hr periods)5-days and 4-nights (4-24hr periods)Other (Please include in the pertinent notes above)
Expected Participant Number*
What grade are the expected participants? *

What are your anticpated cost outside of KSS's program cost? *

What other funding options are being explored? *

Total Amount Requested:
Statement of Need and Impact
In detail, please explain why financial aid is necessary for your group to attend.
- What impact would this experience have on this group of students?
- How a visit to KSS will be incorporated into classroom learning (if applicable)?
- Are there any special circumstances relating to your group and their ability to come to this program (demographics, income, antidotes about students, current classroom environment, etc)?
- Is there any other information on the group that could interest a funder?
Should be Empty:

Group Program Financial Aid Application