Habitudes Grant Application for Prospective Schools

1

School Information:* This field is required

Principal's Name:

School Name:

County/District:

State:

School Website:

Press
Enter

2

Primary Contact Information :* This field is requiredThis is the person who will be the main point of contact for all grant details and reporting.

Name:

Job Title:

Email Address:

Phone:

Press
Enter

3

What grades are served?* This field is required

Press
Enter

5

Organizations Ethnicity %* This field is required

Percentage

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Other

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Other

Percentage

Press
Enter

6

What percent of students receive free & reduced lunch?* This field is requiredStudent Nutrition Data

Press
Enter

7

How do you plan to use the Habitudes system? Please write a project description.* This field is required

Press
Enter

8

When do you foresee implementing Habitudes within your school?* This field is required

Advisement or Homeroom Period

Academic Classroom

After-school Program Meeting

Extracurricular Organization or Sport

Press
Enter

9

How often would you hold Habitudes lessons?* This field is required

Press
Enter

10

In what timeframe will Habitudes be taught?* This field is required

Press
Enter

11

How many students by grade level or age will be taught Habitudes?* This field is required

Press
Enter

12

How many adult leaders will facilitate Habitudes lessons with students?* This field is required

Press
Enter

13

Why do you want to implement the Habitudes program at your school? This is your chance to explain your school's and/or community's needs Tell us your story. What is it that you need to tell us about your school/community that explains how Habitudes will strengthen your students? How will the program benefit your students specifically?* This field is required

Press
Enter

14

The Growing Leaders Initiative often grants organizations a "pilot year" to implement on a small scale before rolling out organization or school wide. This helps us identify best practices and needs for the partnership. Please describe what a "pilot year" would look like, if approved?Please include number of adult leaders to facilitate Habitudes Lesson and number of students you plan to implement with.

Small
Normal
Large
Huge

Press
Enter

15

Legal Structure of your group:* This field is required

We have our own EIN# (an EIN# is your Employer Identification Number- EIN). It is also known as a Tax Identification Number (TIN) or Federal Tax Identification Number (FIN). Please note that this is not the same as your Tax exempt Number and 501(c)3 status. (If selected as a grant recipient we will need to see a copy of your IRS determination letter.)

We are applying under our non-profit status. (If selected as a grant recipient we will need to see documentation confirming your non-profit status on your organizations letterhead.)

Press
Enter

16

Please provide your EIN (or tax ID #-9 digits in length) if applicable.

Press
Enter

17

How did you hear about The Growing Leaders Initiative?

Colleague/Friend

Conference/Event

Website/Google Search

Tim Elmore's Blog

Press
Enter

18

Below are conditions and requirements of the grant:* This field is requiredBy clicking each box you are acknowledging every requirement.

Press
Enter

19

The Growing Leaders Initiative reserves the right to withhold and/or cease access to resources if the above requirements are not met.* This field is requiredBy clicking the box below, you are agreeing to meet all requirements as stated before.

Press
Enter