Calumet Regional Science Fair & Associated Art Exhibit
Grant Application

Address: __________________________________________________

City, State, Zip: _____________________________________________

E-mail address: ____________________________________________

Fax #: ____________________________________________________

Phone: ___________________________________________________

School: ___________________________________________________

School Address: ____________________________________________

School e-mail: ______________________________________________

School phone: ______________________________________________

Project Title: ________________________________________________

Sponsoring teacher: _________________________________________

Amount requested: __________________________________________

Purpose of funds requested: __________________________________
(attach additional sheet if necessary)

I have read the rules on the Grant page and agree to them.

______________________________   _____________________________
Student Signature                                      Teacher Signature
All necessary protocol must be submitted with the grant form
mail to: Calumet Regional Science Fair
              c/o Chemistry Department
              Indiana University Northwest
              3400 Broadway
              Gary, IN 46408

or fax to: (219) 980-6673
or e-mail to lwoz@iun.edu