SPEF - Chapter Educational Fund Disbursement Request

Grant Information

Chapter Educational Fund Disbursement Request
Grant To: *
Legal Entity Name
To Be Used For: *

Computers and or software purchase or educational technology upgrades Study area desk, chairs, and or other approved furnishings Books, libraries, and academic files Study area renovations
Description of Educational Impact Achieved by Funds *

Educational Programming Information

Chapter Educational Fund Disbursement Request
NOTE: Must comply with US Tax Code and IRS Regulations
Type of Educational Programming *

Mid-Year Leadership Conference Tony Siress Leadership Summit
Reimbursement for: *

Travel Registration
Must Upload Receipt(s) *

Browse Files

Cancel of

Submission

Chapter Educational Fund Disbursement Request
The undersigned understands this is a request for disbursement only and does not constitute a commitment by or contract with the Foundation to disburse funds.

The undersigned agrees to obtain and provide to the Foundation any documentation and other information needed to verify use of any disbursed funds, as requested.

The undersigned agrees that any funds disbursed as a result of this request, but not used for the purposes set out in this request, must be returned to the Foundation.
Your Signature *

Clear
Your Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Your Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
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General Information