North Carolina Science Teachers Association

NCSTA Study Grant Application

First Name *

Last Name *

Email *

First Name *

Last Name *

Membership Expiration Date *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

School or Organization *

Please summarize how you intend to use this grant. Include specific information regarding purpose, other individuals involved and anticipated benefits to the classroom. *

Total amount requested from NCSTA *

Please itemize how your grant will be spent. Include amount(s) and description(s). *

General Guidelines

I agree to abide by the general guidelines for this grant as described on the NCSTA website (www.ncsta.org).

Non-transferable

I am aware that these funds are non-transferable.

Tax Information

I understand that before I receive a Study Grant from NCSTA, I must provide my social security number and that I will receive a 1099 for any funds received for an amount of $600 or more.