APPLICATION FORM for a 
SCHOOLYARD HUMMINGBIRD HABITAT
(please print or type)

School Name: __________________________________________________________________

School Address: ________________________________________________________________

		  _________________________________________________________________

School Phone:	__________________________________________________________________

School County (circle one):               Gaston                Mecklenburg               York

Contact Person: ________________________________________________________________

Contact Person’s e-Mail Address: __________________________________________________

Grade(s) Involved in Project (circle):    K    1    2    3    4    5    6    7    8    9    10    11  12

Number of Students Involved: _____________ Number of Teachers Involved: ______________

Discipline(s) Involved: ___________________________________________________________

______________________________________________________________________________

The signatures below indicate that the building principal and contact person support installation, maintenance, and use of a SCHOOLYARD HUMMINGBIRD HABITAT as a tool for enhancing cross-disciplinary learning among their students.

______________________________________________________________________________
Principal’s Name			Principal’s Signature				Date 

______________________________________________________________________________
Contact Person’s Name		Contact Person’s Signature			Date

Attach this form to your cover letter, proposal narrative, and supporting materials and mail unfolded to arrive no later than 5 p.m. on 1 February 2002 at:
Hilton Pond Center for Piedmont Natural History
1432 DeVinney Road
York SC 29745