Choose Your Field Trip Date Please Note: This form does not guarantee a reservation. We will accommodate requests on a first come first served basis.

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1 LEARNING IS WILD SCHOLARSHIP PROGRAM APPLICATION The Learning is Wild Scholarship is made possible by the Cardinal Health Foundation. Please type or print. This form must be completed and sent to the Columbus Zoo and Aquarium at least three weeks prior to your anticipated visit. Please complete one application per field trip request date. School Contact Information School Name School Address City State Zip Code School District School Phone Number County Alternate Phone Number School Fax Number Contact Person Contact Please check here if you would like to receive updates about the Columbus Zoo s Education programs. Choose Your Field Trip Date Please Note: This form does not guarantee a reservation. We will accommodate requests on a first come first served basis. Field trip dates are available September 19, 2016 April 28, Time of Arrival 1 st Choice Date 2 nd Choice Date 3 rd Choice Date Time of Departure 1 Learning is Wild Scholarship Application

2 Tell Us About Your Group Number of Students Participating in Field Trip Grade Level(s) Number of Chaperones What was the date of your school s last field trip to the Zoo? Calculate the Admission Fee Total Number of People x Fee Per Person ($2/Franklin County, $4/Outside Franklin County) = TOTAL ADMISSION FEE $ TOTAL ADMISSION FEE $ 2 Learning is Wild Scholarship Application

3 Select an Education Program If you are interested in upgrading your field trip to include an education program, please select ONE of the three education programs listed below. Visit for more information about each of these options. Select ONE Education Program Step One Select ONE Topic Step Two Calculate Cost Step Three Interactive Auditorium Program Maximum 200 students per day. PreK/K (30 min. per program) My Favorite Things (Habitats) Ohio s Backyard Animals A Tiger s Roar (Rainforest animals) Grades K-12 (45 min. per program) Discover Ohio s Animals (Gr. K-2) Animal Body Coverings (Gr. K-2) Polar Expedition (Gr. K-2) Wild Adaptations (Gr. 2-6) Animal Classification (Gr. 2-6) Food Webs (Gr. 2-6) Finding Fossils (Gr. 2-6) Careers (Gr. 6-12) Maximum of 200 students can participate in the Interactive Auditorium programs per day. Total Students / 50 students per program= Total Programs Total Programs x Fee ($40/Franklin County, $50/Outside Franklin County) = TOTAL PROGRAM FEE $ 3 Learning is Wild Scholarship Application

4 Adventure Tours Maximum 100 students per day. Grades 1-12 (45 minutes per tour) Extreme Animals: North America Region (Grades 1-12) Extreme Animals: Asia Quest Region (Grades 1-12) Furry, Feathery, Scaly: Shores and Australia Region (Grades 1-12) Maximum of 100 students can participate in the Adventure Tours per day. Total Students / 25 students per program= Total Programs Total Programs x Fee ($20/Franklin County, $25/Outside Franklin County) = TOTAL PROGRAM FEE $ Animal Observation Inquiry Available March & April only. Maximum 100 students per day. These programs are designed for students in grades (30 minutes per program) Brown Bear Observation Elephant Observation Penguin Observation Tiger Observation Maximum of 100 students can participate in the Animal Observation Inquiry per day. Total Students / 25 students per program= Total Programs Total Programs x Fee ($20/Franklin County, $25/Outside Franklin County) = TOTAL PROGRAM FEE $ TOTAL PROGRAM FEE $ 4 Learning is Wild Scholarship Application

5 Transportation The Learning is Wild Scholarship will pay a MAXIMUM of $300 towards transportation PER SCHOOL during the school year. Contact Laura at schoolprograms@columbuszoo.org or to inquire if transportation funds have already been utilized by your school during this funding cycle. Applicants who receive transportation funds are required to submit proof of payment for their transportation by the designated due date. Transportation Reimbursement Due Dates: Field trips taking place between September 1, 2016 and December 2, 2016 must submit their paid invoice by December 15, 2017 to guarantee reimbursement. Field trips taking place between January 1, 2017 and April 28, 2017 must submit their paid invoice by May 15, 2017 to guarantee reimbursement. The Zoo will not pay the transportation company directly for transportation services. Once the Zoo receives the paid invoice, the Zoo will reimburse the school for the amount listed in the Scholarship Award Agreement or 75% of the submitted invoice (whichever is a lesser amount). Calculate the Transportation Fee Total Number of Buses x Fee Per Bus = TOTAL FEE $ TOTAL TRANSPORTATION FEE $ 5 Learning is Wild Scholarship Application

6 Determine Overall Field Trip Cost A. TOTAL ADMISSION FEE (Page 2 of Application) $ B. TOTAL PROGRAM FEE (Page 4 of Application) $ C. TOTAL TRANSPORTATION FEE (Listed Above) = $ Please add each TOTAL on lines A, B and C to find the GRAND TOTAL FOR FIELD TRIP = $ Calculate Scholarship Request Amount A. Please consider all possible funding sources. Our school can contribute $ toward the cost of this field trip. B. We are requesting funding support in the amount of $ from the Columbus Zoo and Aquarium. This amount cannot exceed 75% of the total field trip cost. The Zoo will pay a maximum of $300 toward transportation PER SCHOOL. Statement of Need You must complete sections A, B and C to be considered for funding. A. List your school s Free and Reduced Lunch Percentage B. In a separate letter, please detail your school s need for funding. Be sure to include information, such as participation in government assistance programs (Free and Reduced Lunch Program, Aid to Families with Dependent Children, Title 1), your school s budget, and/or other indicators of financial need. C. Statement detailing how a Columbus Zoo field trip will be incorporated into the classroom experience to educationally impact the participants. 6 Learning is Wild Scholarship Application

7 Applicant Agreement Schools will be required to provide payment for their portion of this experience when they arrive at the Zoo for their field trip. Recipients must bring the Scholarship Award Agreement with them to the Zoo in order to receive their reduced admission and program fees. Applicants who receive funding for transportation will be required to submit proof of payment for their transportation services. The Zoo will not pay the transportation company directly. Once the paid invoice is received, the Zoo will reimburse the school for the amount listed in the Scholarship Award Agreement or 75% of the submitted invoice (whichever is a lesser amount). Print Contact Teacher Name Signature of Contact Teacher Date Print School Administrator Name School Administrator Title School Administrator Signature Date Scholarship funding for the Learning is Wild program is made possible through grants and donations. As a good steward, the Columbus Zoo and Aquarium provides all program donors with a final report highlighting outcomes and testimonials from each academic year. Zoo staff may contact scholarship recipients (educators and students) to request feedback as part of this reporting process. Feedback can be used to report on grant outcomes or to promote the scholarship opportunity. Thank you for your cooperation! 7 Learning is Wild Scholarship Application

8 PLEASE RETURN THIS COMPLETED APPLICATION TO: By Mail: The Columbus Zoo and Aquarium Education Department 9990 Riverside Dr., PO Box 400 Powell, OH Confirmation When ing the application, you will receive an reply confirming the receipt of the application within 72 hours. If your scholarship application is approved, you will receive an award within two weeks of submitting your request to the Learning is Wild Scholarship Program. Please keep this - it will contain important information about your award total, education program scheduling, and field trip details. Questions? or call Laura Orsini at Learning is Wild Scholarship Application