Apply

*(denotes required field)

First Name: *

Last Name: *

E-Mail Address: *

E-Mail Address again: *

Please enter your E-mail Address a second time.

Mailing Address *

Phone Number *

---

What event are you applying for a grant for admission to? *

Where and when does this event take place? *

Note: Separate travel grants may be considered but this application is for admission to events only. If you need help with travel associated costs you will still be considered for this grant and I will contact you prior to awarding the grant to get more info from you.

Can you afford to get to the event and find hotel accommodations/place to stay during the course of the event? *

Yes No

Are you a student? If so what do you study and what school are you attending? *

Do you have a blog or a website? Twitter?

---

In fewer than 500 words each, please answer the following questions:

What is the coolest thing you have learned? *

Who is/are your lady-science or secular heroes and why?

What is your favorite science topic? *

If you could time travel what year would you go to and why? *

What do you hope to get out of attending this event? *

Have you attended this event in the past? *

No Yes

EXTRA CREDIT #1: In under 140 characters, tell us what makes you awesome.

CAPTCHA Code: *