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Bruce Munro Student Extensions Bus Subsidy/Scholarship Form

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* 1. School Information:

School Name

City

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* 2. Contact Information:

Teacher Name

Organizer Name

Phone

Email

Cell or alternate number to contact during summer (optional)

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* 3. Grade(s):

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* 4. Will you need a bus subsidy?

Yes

No

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* 5. If yes, what is the approximate cost of your bus or buses?

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* 6. Number of classes (defined as a group of up to 25 students) attending:

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* 7. Number of adults attending:

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* 8. Select your preferred art activity track:

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* 9. Are you a Title One school?

Yes

No