Forms

* this field is required

NCSTA Study Grant Application

* 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.