Application form for aid request

LabAid aims to provide students in developing countries with the chance to see and handle apparatus essential to their course work and practical examinations in Physics, Chemistry and Biology. LabAid can supply, free of charge, small quantities of many basic items of science equipment. Note: we cannot supply chemicals.

If you know where there is a need for this help, please fill out the form below.

Please complete all sections below

Country
School Name
School Address
Postal Code /Zip
Nearest Large Town or City
Phone Number
Applicant’s Name
Email Address
Position Held
Subjects Taught
How long do you expect to be at the school? years
Does the school have a website?
Yes No
If no, is the school listed on any website?
Yes No
Headmaster's Name
Head Science Teacher's Name
UK based references:
Name
Does the school have a science laboratory?
Yes No
Does the school have some science apparatus?
Yes No
If yes, please list the items
We are looking for the
following apparatus
Tick which of the following services are available to you
Water Piped GasPiped
Well Bottled
Stream None
Mains Electricity    

[what is your voltage?]
I can visit LabAid to choose & collect apparatus
Yes No
If yes, when do you plan to visit LabAid
I wish to use a contact in the UK who can liaise with LabAid
Yes No
Liason's Name
Address
Liason's City
Phone Number
 

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