Your Contact Information: First Name: Last Name: Email: Title: Department: Classes Taught: Grade Level of Students: School Name: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ZIP: School Phone: Phone Number: Best Time to Reach You (Optional): How did you hear about FIDM’s Just for Educators site? Please select one… Search Engine Another Website Speaker in Class Colleague College / Career Fair Conference Information Packet Fashion Club Television Show Brochure Postcard Event at FIDM Other Comments
Information for the Field Trip: Campus Choice 1 Please select one… Los Angeles Orange County San Diego San Francisco Campus Choice 2 Please select one… Los Angeles Orange County San Diego San Francisco Date You Wish to Visit Choice 1: Date You Wish to Visit Choice 2: (Please note, this grant may NOT be used for DEBUT) Number of Adults in Your Group: Students: (Requirement for Eligibility: 1 Adult per 10 Students) Principal / Administrator Name: Title: Phone: Ext: Budgetary Award Request: How did you hear about FIDM’s Just for Educators site? Please select one… Search Engine Another Website Speaker in Class Colleague College / Career Fair Conference Information Packet Fashion Club Television Show Brochure Postcard Event at FIDM Other If your transportation and substitute teacher costs exceed the $2,000 FIDM grant, please indicate your already committed funding sources. The FIDM Field Trip Grant is contingent upon your securing the additional financial support required. Comments (Including any additional locations / venues for your trip): How will this type of trip benefit your students? (100–150 words)
Signature: Date: By checking this box, I acknowledge that the above typed signature qualifies as the legally binding equivalent of my handwritten signature. By checking this box, I acknowledge that I have read and agree to the rules, terms, and conditions regarding this grant, as provided in the Grant Rules & Regulations.