District 219 Grant Application
Applicant Name (Staff Member Name):
*
First Name
Last Name
Applicant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant Email
*
example@example.com
Students' Name
*
Students' Email
*
example@example.com
Grant Information
Note: Individual student grants cannot exceed $2,000. Student must qualify for free and reduced lunch.
A. Total Cost
*
B. How much is being paid for by (a dollar amount must be given for each. Write "$0" if the answer is zero):
*
Rows
Amount?
School District
Family Contribution
Student
Other Sources
TOTAL:
C. How much are you specifically requesting from the Education Foundation? (Subtract B TOTAL from A)
*
Date Needed By: *Please note that if the request is submitted less than 30 days from the time funds are needed, there is no guarantee that the request may be approved in time.
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check Payable to (name of organization, not individuals):
*
Check Should Be Made Payable To (cannot be paid out to individuals):
*
Attention to (Include first and last name, if applicable):
*
Address of Organization
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proof of Need (please see our website for list of approved forms)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Letter of support from counselor (if grant is for specific students)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
How will this grant directly support your goals or initiatives? Include specific examples of how the funds will be allocated and the expected outcomes:
*
Applicant's Signature
*
Department Head Signature
*
Submit
Should be Empty: