GRANTS PROGRAM FOR K-5 SCIENCE & MATH EDUCATION

APPLICATION FORM

Please fill out the gray text field. All fields are required.

School Name
Enter Full Name of School
Address (Street, City, State, Zip)
Enter the address of the School
Teacher (Title, First Name, Last Name)
Enter Teacher's Name
Phone (Work) / E-mail (Work)
Enter Teacher's work phone number / Enter Teacher's work email address
Phone (During Vacations, After School) / E-mail (During Vacations, After School)
Enter Teacher's alternate phone number / Enter Teacher's alternate email address
School Administrator
Enter Administrator's Name
Phone (Work) / E-mail (Work)
Enter Administrator's phone number / Enter Administrator's work email address
Project Title
Enter the Project Title
Project Grade(s) / No. of Children Involved / Project Start Date / Project End Date
Enter Project Grade(s) / Enter No. Of Children Involved in this project / Enter Project Start Date / Enter Project End Date

Please summarize your project idea in a short paragraph:

Enter BRIEF project summary

Please describe the following in as much detail as possible within the space provided:

  • Student Learning Objectives

Please describe the student learning objectives
  • Methods of Instruction

Please describe your methods of instruction
  • Project Timeline

Please list your project timeline
  • Method of Evaluation

Please describe your method of evaluation for this project

BUDGET

List items to be purchased and costs. Combine like items so that there are no more than six categories.

1.Item #1 / $0.0
2.Item #2 / $0.0
3.Item #3 / $0.0
4.Item #4 / $0.0
5.Item #5 / $0.0
6.Item #6 / $0.0
Total Request (may not exceed $1,000) / Enter budget total

Please explain how the materials listed in the budget above will be used.

Please summarize your project idea and explain how the materials listed in the budget above will be used

CERTIFICATIONS

“I certify that the applying teacher is employed by my school, that I am aware of his/her project, and that I will provide the support necessary to allow the project to take place in a timely fashion.”

Signature of School PrincipalDate

“I certify that the proposed project is in addition to what I usually do to teach science or math to my students.”

Signature of Applicant (teacher)Date

_____ I teach at a public school; or

_____ I teach at an eligible private (non-profit) school. Private school teachers must attach a IRS 501(c )(3) tax exemption letter or qualifying state tax exemption notice to the application. Applications without this documentation cannot be accepted.

Have you previously requested a Toshiba America Foundation grant?

Yes No

If yes, was your project funded?

Yes No

How did you hear about Toshiba America Foundation?

TAF Website Internet Search Colleague Recommendation NSTA Convention Other

If Other, please explain: Other

Submit your completed application to

Please include your school name & the request amount in the subject line of the e-mail.

If you prefer to submit your application by mail, please send three paper copies to

Toshiba America Foundation

1251 Avenue of the Americas, 41st Floor

New York, NY 10020