Date:______________________________

School/Group/Individual:_______________________________________________________________________________________________________________________________________

Contact Person:_________________________________________________________________

Other Financial Sources Being Pursued:_____________________________________________

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Amount Requested From Foundation: $______________________________________________

($2,000/school limit)

Amount of Match: (1:1 Match Required): $___________________________________________

(The match may not be made from existing school budgets)

Activity/Materials To Be Used in Project:____________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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A. How does the project directly relate to the instruction and benefit of students?

B. How will the project continue to increase student performance?

C. How does the project address the required State School Curriculum?

D. How will the project positively effect the school or district?

Please describe the complete project related to this request. Include the number of students involved, the total amount of the project, the amount being requested for match, and at least one major goal of the project. Helpful information may include such things as number of fund raisers being proposed, amount of match of being deposited into the foundation, any past success from similar project. (1 page)

Complete Budget of Project including Foundation Match (Optional)

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