Mini-Grant Application Form

Mini-Grant Application Form
The Learning Lamp is offering start-up grants of up to $1,000 for new and soon-to-open child care providers in the Alleghenies region. (This area includes Bedford, Blair, Cambria, Fayette, Somerset, and eastern Westmoreland counties.) The grant may be used to purchase furnishings, materials, and supplies for child care classrooms. This includes cribs, tables, chairs, shelves, toys, curriculum, and other items needed to open a program. Items should be listed in the application form along with cost. Items purchased must meet child care safety standards and licensing guidelines. To be awarded a grant, the applicant must complete the form below and agree to comply with the following grant guidelines:

1. Applicant must be in the process of starting a licensed child care program. Family-based providers will receive priority. Other types may be funded if money is available.

2. Applicant must have space selected and be actively working toward obtaining a license.

3. Applicant must provide a description of the child care services to be provided, including location, hours, age groups, and the number of children to be served.

4. Applicant must provide receipts for items bought within 30 days of purchase. Receipts should be emailed to Anna at azettle@thelearninglamp.org.

5. If the child care provider does not open, for whatever reason, items purchased must be returned to The Learning Lamp for redistribution to other licensed child care programs.
Date of application*

MonthDayYear
Date
Legal name of the organization applying*
Director/Owner name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Contact person (if different from Director/Owner)

First NameLast Name
Address of the organization applying*

Street Address

County

CityState

Zip Code
Amount requested (up to $1,000)*
Purpose of grant (two sentences):*
Estimated number of jobs created:*
Number of children served by your program:*

List of items and cost of each item:*

	Name of item and description	Price
Item #1
Item #2
Item #3
Item #4
Item #5

If more space for purchased items is needed, please email a document containing all required information to azettle@thelearninglamp.org
Will this mini-grant be used for reimbursement of past purchases?*

YesNo
Upload a photo of your facility / the funded project

I understand that by uploading a photo, I am giving permission for it to be used in social media and website posts, distributed in promotional materials, shared with community partners, and included in funding requests and reports.
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Signature, Director*

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Date signed*

MonthDayYear
Date
Name and title of signee*
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