Community Partner Application – MY Museum – Monterey County Youth Museum

School Name

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Fax Number

Contact Person *

First

Last

Contact Email *

Contact Phone Number

What's the best way to contact you?

Phone
Email
Mail

Audience served (size & ages)

Number of Students/Adults

Is your school at Title I School?

Please indicate student population percentages:

White

Black

Hispanic Origin

Asian

Native American

Please attach the following to your application:

A copy of your school's/organization's mission statement

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For Non-Profits:

A copy of your organization's 501(c)(3)

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A letter signed by the director, on letterhead, requesting an admission scholarship

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For Schools:

A letter signed by the principal requesting a scholarship & confirming your Title I status (if applicable)

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Answer any of the following questions applicable

Does your school/organization receive special funding (head start, title I, etc.)?

What percentage of your students/group qualify for free or reduced lunch?

What is your funding per child for educational field trips each year?

Do you charge a fee or place restrictions on who can receive your services?

Are there other circumstances that make access to the Museum difficult for your families?

Due to increased requests, how many, if any, of your students could pay:

$3.00

$2.00

$1.00

Is there any other information about your program you wish to share with us? *

Name

Please indicate student population percentages:

Please attach the following to your application:

Answer any of the following questions applicable

Location

Hours

Contact

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