1,000 Hours a Year Initiative: Addressing Lead and Radon in Learning Environments
Please fill out the following questions as accurately and as thoroughly as possible in the space provided.
Checkmark which applies to you
*
School District
Early Learning Center
Other
Name of School District or Early Learning Center
*
Facility Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you located in Allegheny County?
*
Yes
No
Employer identification number (9 digits) - Also known as Federal Tax Identification Number
*
Contact Name
*
First Name
Last Name
Contact Title/Position
*
Contact Phone Number
*
Please enter a valid phone number.
Contact Email Address
*
example@example.com
Checkmark the following types of facilities you have
*
Preschool
Elementary School
Middle School
High School
Daycare
Private/Parochial/Charter School
Group Childcare Home
Family Childcare Home
Other
If you are a school, do you have a child care center on site?
*
Please Select
Yes
No
N/A I am a childcare center
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe. If not, please input N/A
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, copy and paste this link in your web browser: https://ejscreen.epa.gov/mapper/
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, check the map here: https://data.wprdc.org/dataset/environmental-justice-census-tracts
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, check the map here: https://data.wprdc.org/dataset/environmental-justice-census-tracts
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, check the map here: https://data.wprdc.org/dataset/environmental-justice-census-tracts
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, check the map here: https://data.wprdc.org/dataset/environmental-justice-census-tracts
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Lead and Radon Project Grant Application
Grant Details: Please fill out this information for each specific building
Name of building
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Approximate total square footage of building
*
Please provide square footage for your program or school's occupied space
Number of children / students served
*
Please provide the total enrollment for your school or program
Are any of the children you serve residing in an environmental justice community? If yes, please list the community below.
*
If you are unsure if the communities you serve are EJ communities, check the map here: https://data.wprdc.org/dataset/environmental-justice-census-tracts
Percentage of children eligible for free and reduced lunch program (K-12 buildings) Please input NA if you are a childcare center
*
Percentage of children eligible for CACFP, WIC or SNAP programs (early learning centers) Please input NA if you are a school
*
Please select which environmental hazards you wish to address (check all that apply)
*
Lead in water
Lead in paint/dust
Lead in soil
Radon
Air Quality
Besides financial support, what type of assistance would be helpful to you in addressing lead and radon in your facility?
*
On site support
Testing/mitigation procedures
Names of testing and mitigation consultants
Communicating / message
Other
Have you received a grant in the past under 1000 hours a Year initiative to test for lead and radon at your site?
*
Yes
No
I'm not sure
Has your school / center already tested for lead?
*
Yes
No
I'm not sure
Has your school / center already tested for radon?
*
Yes
No
I'm not sure
Have you estimated the cost of testing and / or mitigation / received quotes? If so, please describe.
*
*Please note, that grants range from $1,000 to $7,500 based on availability and demonstrated need
Is there any other funding you have for this project? If so, please describe.
*
Do you have more buildings?
*
Yes
No
Back
Next
Consent and Signatures
The information contained in this application, as well as testing results, will remain confidential. The only information that will be made available to the general public is the name of the entity receiving funds from Women for a Healthy Environment. I agree that the information herein are true and correct. I further agree that I have received approval from my administration to submit this request, with the expectation that it will provide, at a minimum, short-term remediation and create a plan for long-term resolution of lead and radon exposure, as deemed necessary by testing. I agree that if my childcare facility or school is awarded a grant, I will ensure that test results will be shared with my school or childcare center staff, parents, and community.
*
Please sign your name
If there are any other questions, comments or concerns, please address them below.
*
If you have tested for lead and/or radon, please provide documentation of test results below. If you have received quotes for lead or radon testing/mitigation, please submit below.
*
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