National Youth Day Out Application Form
School Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Contact Name:
*
Day Telephone Number:
*
Cell Phone Number:
Fax Number:
Email Address:
*
Name/Contact Information for key person
to be contacted on matters involving this application:
Authorized Representative Name:
*
Authorized Representative Email:
*
Authorized Representative Title:
*
Authorized Representative Phone:
*
Class Demographic Information:
Number of Students:
*
Grade Level:
*
Average Age:
*
Percentage of Students Who Receive Free Lunch:
%
*
Number of Trips Taken This Year:
In narrative form, please answer the following in two hundred words or less:
Please describe why your class deserves to receive the National Youth Day Out field trip at no cost to the school or participating students. Please include the following points in the narrative:
Describe how a “Day Out” will benefit your students and enhance their educational experience.
Explain the trips your class has not been able to take due to lack of resources in your district.
Don’t forget that QUALITY and CREATIVITY of the submission count!!!
*
Certification: To the best of my knowledge and belief, information provided in this application is true and accurate and any support provided through this award program will be used in accordance with stated objectives/program goals. The applying school agrees to comply with applicable special conditions upon receipt and review of relevant agreement documents outlining program and/or use of program materials. In signing this document, the representative is duly authorized by the applicant’s governing body and agrees to comply with relevant assurances if assistance is awarded.
Authorized Representative Initials:
*
Authorized Representative Date:
*
Cancel
*
= Required Fields