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Which subsidy are you applying for?

Pronoun

Title

First Name

Last Name

Phone Number

Personal Email

Some school districts have strong firewalls. Please include a personal e-mail as a backup.

School Name

School Street Address

City

Province

Postal Code

Grade Level(s)

Number of Students

Date of Field Trip

Destination of Field Trip

What MineralsEd resources are you using to supplement this activity?

Number of buses (if applicable)

Reason for the field trip?

Comments

Confirmation

I confirm that I have read all the important information stated above this form.