Schoodic Education Adventure Program 2011 
Student Scholarship Application

•	Information on this form will be kept strictly confidential and will be used solely to determine the amount of scholarship assistance offered by SERC Institute. 
•	Please do not include adults in calculating the scholarship amount requested. 

If you have any questions, contact Acadia National Park’s education office at 207-288-8822. Please fax your application to 207-288-8813 by May 1.  Please print or type.

Number of Participants:		Number of Students
		Number of Adults (Teachers, Parents/Chaperones)
		TOTAL

Estimated Schoodic Education Adventure Fee:
		Total # of students   X   $50 =    $

Describe other sources of funding for your group, including any student fundraising: 

Have you received SEA financial assistance in the past?

Estimated Transportation Cost:

Your Request: 	What dollar amount are you requesting from the Scholarship Fund?   $ 

School Demographics
	Percentage of students eligible for the free lunch program
	Percentage of students eligible for reduced-fee lunch program
	Percentage of students receiving special education services
	Percentage of students considered at-risk
	Percentage of students using English as a second language
	Percentage of students living on an Indian reservation
	Percentage of students living in low-income government housing

Curriculum Goals
Please use the back of this form to explain how your classroom objectives will be met by participating. 

School: 		Telephone:  
Address:	
School Official’s Signature:   	Position:   
E-mail 			                  Date: