Leslie Science & Nature Center
School Outreach Scholarship Application Form
Leslie Science & Nature Center is excited to offer Scholarships to schools thanks to the generous support of our donors.This funding is limited and will be distributed based on need until depleted.
Please fill out in pen and submit the application below by October 21st to qualify.
Turn in your application by email to, or fax to 734-997-1072.
Incomplete or illegible applications will not be considered.
We will notify you by October 28th regarding the status of your application.
Scholarships are limited to one program per classroom per school year.
Today’s Date: ______School name: ______
School Address (Street, City, State, Zip):______
Teacher name: ______Have you done a program with us before?______
Teacher phone: ______Teacher email: ______
Total number of students: ______Grade: ______Number Classes:______Number adults: ______
Our scholarships are awarded to schools in need of financial assistance, based on the percentage of students receiving free and reduced-price lunches at your school.
______% of students qualifying for the free lunch program at your school.
______% of students qualifying for the reduced-price lunch program at your school.
Our scholarships provide partial coverage for the cost of the program. You are responsible to provide the remainder. Payment is expected ahead of time or the day of unless you have otherwise arranged payment with the LSNC office.
There are 2 types of scholarships available and each classroom is eligible for one.
Please check which one you are interested in receiving:
______PreK -12th Outreach Programs (We come to you!) 50%-75% off the regular price
______PreK-5th Field Trip Programs (You come to us!) 75% off the regular price
Please tell us which outreach or field trip program you are most interested in:
Scholarship programs are limited to November – March.
What month(s) are you interested in?______
What dates work best for your classroom? ______
How does this program fit into your curriculum?
______
Why do you feel this program will provide an important experience for your students?
I have read and understand Leslie Science & Nature Center's Cancellation Policy and Scholarship FAQ, and I agree to its terms and conditions.I understand any non-weather cancellation of a Scholarship-supported program will lead to forfeiture of all future Scholarship funds.I understand that a non-weather related cancellation within 48 hours of the start of a program incurs a fine of $75. I agree to call LSNC48 or more hours in advance if my classneeds to cancel, or I agree to pay the $75 fine. Teacher's initials: ______
I understand that failure to pay prior to the Scholarship program or failure to make other arrangements with the LSNC office means that I forfeit all scholarships for my class and school. Teacher’s initials: ______
I understand and am committed to students creating thank you cards and submitting them to LSNC so we can pass them along to Scholarship program donors.Teacher's initials: ______
Teacher's signature: ______
Teacher's name (printed): ______
Principal’s signature: ______
Principal’s name (printed): ______
Leslie Science & Nature Center | 1831 Traver Road, Ann Arbor MI 48105
| 734-997-1553 |