City State Zip Code. School District. Please check here if you would like to receive updates about the Columbus Zoo s Education programs.

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1 LEARNING IS WILD SCHOLARSHIP PROGRAM APPLICATION 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. You will receive notification of the status of your application within two weeks of submitting your request to the Learning is Wild Scholarship Program. 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 2, 2014 April 30, 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 four 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 Discover Ohio s Animals (Grades K-2) Animal Body Coverings (Grades K-2) Polar Expedition (Grades K-2) Wild Adaptations (Grades 2-6) Animal Classification (Grades 2-6) Food Webs (Grades 2-6) Finding Fossils (Grades 2-6) Careers (Grades 6-12) Maximum of 200 students can participate in the Interactive Auditorium programs per day. Total Students / 50 students per Total Programs x Fee ($40/Franklin County, $50/Outside Franklin County) = Handheld Computer Program Maximum 72 Zoo Scene Investigators (Grades 5-8) Treasure Quest (Grades 5-8) Maximum of 72 students can participate in the Handheld Computer programs per day. Total Students / 36 students per Total Programs x Fee ($40/Franklin County, $50/Outside Franklin County) = 3 Learning is Wild Scholarship Application

4 Adventure Tours Maximum 100 Extreme Animals (Grades 1-12) Furry, Feathery, Scaly (Grades 1-12) Maximum of 100 students can participate in the Adventure Tours per day. Total Students / 25 students per Total Programs x Fee ($20/Franklin County, $25/Outside Franklin County) = Animal Observation Inquiry Maximum 100 These programs are designed for students in grades Brown Bear Observation Elephant Observation Penguin Observation Maximum of 100 students can participate in the Animal Observation Inquiry per day. Total Students / 25 students per Total Programs x Fee ($20/Franklin County, $25/Outside Franklin County) = 4 Learning is Wild Scholarship Application

5 Transportation The Learning is Wild Scholarship will pay a MAXIMUM of $300 towards transportation. Number of Buses Needed for Field Trip:. This scholarship application is for a school in the Columbus City School District. We will be using Columbus City School Transportation. The fee for these buses is $175/bus. We will arrange our own buses from a private bus company. The fee per bus is $. Our school is not a Columbus City School. The fee per bus will be $. Calculate the Transportation Fee Total Number of Buses x Fee Per Bus = TOTAL FEE $ 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 = $ Request Funding You must include 1. The amount your school is able to contribute to the cost of your Zoo field trip. 2. The amount of financial aid you are requesting from the Columbus Zoo. The Columbus Zoo will fund a maximum of 75% of your total field trip cost. 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. 5 Learning is Wild Scholarship Application

6 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. Print Contact Teacher Name Signature of Contact Teacher Date Print School Administrator Name School Administrator Title School Administrator Signature Date Confirmation You will receive notification of the status of your application within two weeks of submitting your request to the Learning is Wild Scholarship Program. PLEASE RETURN THIS COMPLETED APPLICATION TO: The Columbus Zoo and Aquarium Education Department 9990 Riverside Dr., PO Box 400 Powell, OH Fax: (614) teacher@columbuszoo.org Questions? teacher@columbuszoo.org or call Becky Nellis at Learning is Wild Scholarship Application