Advance Request Form

ACADEMIC ENHANCEMENT PLAN ADVANCED REQUEST

You are requesting funds $$ prior to purchase.
ADVANCE REQUEST

Funds are being provided prior to purchase. Requested items will be reviewed and you will receive an approval email.
1. Our 1st priority is Academics. Sports and Social opportunities are secondary and will only be considered if we have an indication of good academic performance.
2. Requests must be received no later than the 10th of the month.
3. We only approve 50% of funding per semester.
  K-8 scholars: $900/year per scholar. Up to $450.00 can be requested each semester.
  High School scholars: $1200/year per scholar. Up to $600.00 can be requested each semester.
4. If you are a private school family requesting part of your scholarship funding, please provide specifics for request. We will inform school of the reduced scholarship towards tuition.
5. A W-9 must be completed before a check is issued to you.
Please ONLY submit (1) form for ALL scholar requests MONTHLY.
Have you submitted all receipts from your last request? If your response is NO, your request for funds will NOT be APPROVED until ALL receipts have been received.*

YesNoThis is my 1st Request
Parent Name: *

First NameLast Name
What county do you live in
Scholar Name 1: *

First NameLast Name
Scholar Education Option

Traditional Public (District Schools)Charter Public (Independent Public Schools)Homeschool (At Home Instruction/even if connected with homeschool connection programs)Private (Tuition Based - Full or Hybrid (2/3 days Homeschooling)
Grade for Scholar*

K-89-12
Please note request for Scholar 2 (if you have NO request for scholar 2 proceed to details of request)*

YesNo
Scholar Name 2:

First NameLast Name
Scholar Education Option

Traditional Public (District Schools)Charter Public (Independent Public Schools)Homeschool (At Home Instruction/even if connected with homeschool connection programs)Private (Tuition Based - Full or Hybrid (2/3 days Homeschooling)
Grade for Scholar

K-89-12
PARENT COORDINATORS ONLY

If you are NOT a Parents Challenge Parent Coordinator, please do not request reimbursement for a 3rd child.
Please note request for Scholar 3 (if you have NO request for scholar 3 proceed to details of request)*

YesNo
Scholar Name 3:

First NameLast Name
Scholar Education Option

Traditional Public (District Schools)Charter Public (Independent Public Schools)Homeschool (At Home Instruction/even if connected with homeschool connection programs)Private (Tuition Based - Full or Hybrid (2/3 days Homeschooling)
Grade for Scholar

K-89-12
DETAILS OF REQUEST
Based on my scholar(s) academic performance in school, I would like to use the Parents Challenge Grant money to help improve his/her performance in: (Please ONLY check the categories that apply to your request).*

Technology, i.e. computer/laptop, printer, cartridges, softwareAcademic Performance, i.e. tutoring, counseling, brain trainingMath Skills, i.e. tutoring, software programs, books, online resourcesReading Skills, i.e. tutoring, books, online resources, reading success skillsWriting Skills, i.e. tutoring, software programs, books, online resourcesScience Skills, i.e. tutoring, software programs, books, online resourcesSocial Aptitude, i.e. sports, music, theater, karate, gymnasticsMental Health, i.e. counseling, play therapy (we do not pay for prescriptions)Transportation, i.e. bus pass, bike (traveling to/from school), mileage # of miles to and from school x .13/mile (must provide gas receipts)Clubs, Speech, Camps, School TripsUniforms (we do not pay for regular cloths, shoes, etc.)Other
To help my scholar(s) improve in these areas, I plan to use the financial resources for the following. Please be specific on the amount of requests. We must have a TOTAL amount requested: *
Please list the details of the items checked above (be specific).
Total Amount Requested:*
Advancement

When we provide you money prior to you purchasing items, all receipts are due 30 DAYS after check is issued.
Parents, an advancement request allows you the opportunity to not utilize your own personal funds to purchase items that will support your scholar(s) educational needs. Please be prepared to return the receipts for those items purchased with Parents Challenge funds within the 30 day time period. By checking this box, you agree to meet that requirement. If we have to follow-up with you to receive receipts we will no longer extend an advancement option for your family. Thank you for your understanding.*

Yes, I understand and accept these terms.
Do you prefer an electronic payment or paper check?*

Electronic PaymentPaper Check
Please confirm your address: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Reminder: Receipts for purchases must be submitted within 30 days of receiving the check. If receipts are not submitted during that time, future requests for funds will be on an approved reimbursement basis ONLY.
I understand/agree that I will return receipts for all purchases made with the grant money received from Parents Challenge:*

Yes, I agree
Should be Empty:

ACADEMIC ENHANCEMENT PLAN ADVANCED REQUEST

PARENT COORDINATORS ONLY

DETAILS OF REQUEST

Advancement