Applicant Sname(S)Andposition/Title

NEWLENOXSCHOOLDISTRICT122FOUNDATION E3FUNDINGREQUESTAPPLICATION

2017/2018SCHOOLYEAR

DEADLINE:ApplicationsmustbereceivedbyMay1,2017.AnyapplicationreceivedafterthisdeadlinewillNOTbeconsidered.Additionalcopiesofthisapplicationareavailableonlineat:“

,mailedtotheNLSD122Foundation(NLSDF)atPOBox1192,NewLenox,IL60451orsubmittedtotheNLSD122Districtoffice.AwardstobeannouncedonoraboutMay20, 2017.

Theapplicationmustbefullycompleted,andincludethesignaturesofallapplicantsandthatoftheSchool’sAdministrator/Principal.Applicationsareincompletewithouttherequiredsignaturesandwillnotbeconsidered.Pleasebeadvisedthatadditionalinformationmayberequestedforclarification.

Applicant’sName(s)andPosition/Title:

Email(required):Phone(work):Phone(Cell):ProjectTitle:

School(s)thatwillbenefit:

TotalProjectCost:AmountRequested: NumberofStudentsServed: GradeLevel(s):

IftheNewLenoxSchoolDistrict122Foundation(NLSDF)awardsfundsforthisproposal,Iagreetoexpendthesefundsonitemsdescribedintheproposalbudgettoaccomplishtheobjectivesdescribed.Ifawarded,IwillprovideaProjectCompletionReport,within60daysofimplementation,thatincludesallexpendituresandcopiesofreceipts,andIwillreturnanyunexpendedgrantfunds(orthosenotanticipatedtobespent)totheNLSDF.

Applicant(s) Signature(s):Date:

Date: Date: Date:

IMPORTANT!Bysigning,Iacknowledgemysupportandapprovalofthisgrant request. PleasecontactNLSDFifyouhavequestionsorwishtoofferfurtherclarification.

SchoolAdministrator’sSignature:Date: SchoolAdministrator’sNamePrinted:

District Administrator’s Review (initial) ______Date ______

ProjectDescription:

Pleaseprovideabriefdescriptionoftheproject,whythereisaneedwithintheSchoolorDistrictforthisprojectandtherationalewhythisprojectshouldbefunded. Is this request something that the school district plans to fund or could fund?

ProjectObjectives:(Conciselystatetheobjectivesandwhatoutcomesyouexpectasaresultoffundingthisproject.)Explainwhytheprojectisimportantandhowitwillbenefityourstudents.Bethorough.Ifapplicable,youmayincludeanyresearch,tofurtherendorsetheneedthat“ties-in”inyourproposal.

ProjectOrganizationandManagement:

Whoisresponsibleforandwhowillbeinvolvedinyourproject?Explainhowitwillbeorganizedandmanaged.Whatwilltakeplace;whereandwhenwillitoccur?Howmanypeoplewillbenefit?

Budget:(Detailcostsassociatedwithyourproject.Includespecificinformationsuchaskindsofmaterials,servicesandequipmentneeded.Listsourcesifsuppliesandcosts,orotherresourcesthatwillbeinvolvedtocompletetheproject.Budgetshouldincludeprojectcostssupportedbytheapplicantorthird-partycashorgrantsandin-kindcontributions(cost-sharing).)Specifically,howwillthesefundsbespent?

BudgetCategory(listitemsbelow) / Amount
I.Materials(equipment,books,supplies,etc.) / $
II.Other / $
Projecttotal: / $

Willthisprojectreceiveadditionalfundingfromothersources?NO

IfYESpleaseexplain.

ProjectImpacts:(Anticipatedshortandlong-termeffectstheprojectmayhaveonstudentsand/ortheschooldistrict.)