School Name *

School Address *

City *

State *
AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip *

School Phone *

School Fax

Applicant E-mail *

Are You the Teacher? *
YesNo
If No, Name of Classroom Teacher

If No, Additional E-mail for Teacher

Name of Principal *

Best Method of Contact And Time To Reach You *

Grade *

Pre-K

Kindergarten

1st Grade

2nd Grade

Other

Number of Students in Classroom *

Students Receiving Free or Reduced Lunch This opportunity is only for classrooms that serve 50% or more students receiving free or reduced lunches.*
– Select –50-75%More than 75%

Documentation (500k file upload size limit) Please attach an official school document on school district letterhead confirming the percentage of children on free or reduced lunch.*

Explain how the students from your classroom will benefit from a field trip to Kohl Children’s Museum *

Is there any other information you’d like us to know? *

How did you hear about this opportunity?