K-12 Education Program Request Form
School or group name:
Teacher or group leader:
City: Zip: County:
Number of Students: Grade Level(s): Number of Adults:
Have you visited the museum before? Yes No
Requesting a SCHOLARSHIP? NO YES* (Separate form below) *50% of students must be eligible for free or reduced lunch
Do any students have any special needs of which the instructor should be aware?
List any educational goals or subjects of interest.
Program Options: (please choose one)
Thanks to a generous gift from Pacific Continental Bank, and support from the museum store, Past and Presents, the University of Oregon Museum of Natural and Cultural History is pleased to offer scholarships for school groups who wish to visit the museum during the 2016-17 academic year.
Guidelines and Eligibility:
Name of School:
Number of Students eligible for free or reduced lunch: 0-49% 50-74% 75-100%
University of Oregon Museum of Natural and Cultural History 1680 E. 15th Ave.Eugene, OR firstname.lastname@example.org