Equipment Request
Name of person completing request
*
First Name
Last Name
Email address of person completing request
*
Confirmation Email
School or Community Site Name
Total grant amount from CNCM for the current school year
*
What equipment would you like to purchase?
*
What is the requested amount from the CNCM grant that will be used toward the equipment purchase?
*
What is the total cost of the equipment?
*
If the exact price is unknown, please provide an estimate.
Do you have any other partners who are supporting the purchase of this equipment?
Please describe how this equipment will benefit your program.
*
Will your program use any of the CNCM grant toward any other equipment or supplies?
Yes
No, we will only use the remainder of the CNCM grant for food.
If yes, what amount do you expect to use?
Please indicate the dollar amount for OTHER equipment/supplies, not including the amount that is being requested in this form.
Total amount of CNCM grant that will be used for equipment/supplies:
This field is auto-filled from previous answers.
Amount of CNCM grant remaining for the purchase of food:
This field is auto-filled from previous answers.
Submit Request
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