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) / AmountI.Materials(equipment,books,supplies,etc.) / $
II.Other / $
Projecttotal: / $
Willthisprojectreceiveadditionalfundingfromothersources?NO
IfYESpleaseexplain.
ProjectImpacts:(Anticipatedshortandlong-termeffectstheprojectmayhaveonstudentsand/ortheschooldistrict.)