Field Trip Scholarship Request
Please complete this form to request a scholarship funded field trip. Please be advised that this is only a request, and your reservation will not be considered confirmed until a signed contract is received. A member of our staff will be in contact by email to approve your request. Please add info@hwstl.org to your contacts to avoid any spam filters. Feel free to email us if you have any questions about completing your request.
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Email *
Name of School *
Address *
City, State, Zip Code *
School District
Contact and/or Teacher Name *
Contact Phone Number *
Date & Time Preference 1 (Date should be at least 2 weeks away) *
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Date & Time Preference 2 *
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Date & Time Preference 3
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What percentage of your school qualifies for free and reduced lunch? *
How many students are you requesting to be covered under this scholarship? This scholarship may cover the admission costs of every student, as well as chaperones at a 10:1 ratio. Extra chaperones over this ratio are welcome but will cost $5 each. *
Grade(s) of students *
How many chaperones will be attending this field trip? This scholarship may cover the admission costs of every student, as well as chaperones at a 10:1 ratio. Extra chaperones over this ratio are welcome but will cost $5 each. *
Do you have a show preference? If you do not choose a show, or if the chosen show is unavailable for your request, HealthWorks! staff will select a show for you based on the grade(s) or your students. View our show options at https://hwstl.org/whats-happening/learning-theatre-programs/ *
What show/field trip format are you wanting to participate in? Subject to availability. *
For In Person or Travel Show groups, would you like to add a gift shop item for each child to your order at the rate of $2 per child? (Response will not affect scholarship for admission) *
For In Person groups, would you like to add a lunch room rental onto your reservation for $35 (discounted from the usual $50)? This will add 30 minutes to your total itinerary. [$35 for groups of 50 or less; $1 per additional child past 50 (ex. 65 kids=$50] *
Please tell us why you are applying for scholarship funding and why you qualify for assistance. *
If selected to receive a scholarship, would you be willing to administer a student pre-test and post-test to help HealthWorks! evaluate their programming? *
Is your school a Little Bit partner? *
Is your school located in Jefferson County, MO? *
Would you like to be added you to our email and/or texting list? 
(If yes, select the lists you would like to be added to)
Clear selection
If you opted YES for email or texting list, but you would like to use a different email/phone number than listed above, please input the correct contact info below:
Notes/Questions?
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