Proposed project title

Applicant name

First Name

Last Name

Position

School

Email address

Applicant phone number

(###)

###

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Co-applicant name (if applicable)

First Name

Last Name

Co-applicant position (if applicable)

Co-applicant school (if applicable)

Co-applicant email address (if applicable)

Co-applicant phone number (if applicable)

(###)

###

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Additional co-applicants and positions (if applicable)

1. Total amount of funds requested

2. Specify how funds will be allocated (provide line item breakdown)

3. Describe your time frame for using grant funds.

4. Are other schools/organizations or individuals (in addition to the applicant or applicants) involved in assisting with preparation of this application or in any aspect of the proposed project?

YES

If YES, please specify who is involved and the nature of the involvement.

5. Are you aware of other possible funding sources or other substantial support for implementing this project (eg, the school, PTA, the District, government grants, individuals, or community organizations)?

YES

if YES, please specify.

If other funding may be available to offset the amount of the grant request, have you sought or do you intend to seek such funding?

YES

6. Did Principal or Department head approve this request?

YES

Name of Principal or Department Head:

Please list and provide email address

7. How many students (by grade/class/team) and/or teachers would be served by this project?

8. How was the idea for this project generated and who (within the District or the community was important in initiating the grant process?

9. Provide a brief description of your project and explain why this project is important for the District, students, teachers and/or other staff members.

10. Objectives — Define the intended benefits/outcomes of this project for students in the District and any other persons or organizations affiliated with the District.

11. Implementation — Describe how this project will be implemented (including any requirements to reorganize classroom or other space and specifying whether implementation will take place during the school year or over the summer) and how your experience and ability will enable you to implement the project. If any assistance will be provided by anyone not on District staff, please describe.

12. If this will be an ongoing program, how will it be funded in future years — eg, self-perpetuating or other forms of funding?

13. Evaluation — How will the effectiveness of this project be measured? For example, identify the number of students/teachers served and the data that will be collected to demonstrate the benefits/outcomes.

14. If staff development/training is anticipated as part of the project, please provide the following:

a. Description of the requested staff develop,emnt program and explanation of why you feel it is necessary:

d. Number of hours/days of training required:

e. Identity of trainer (eg, a District employee or outside vendor):

f. Training will occur (select one)

Within contractual hours but NOT during classroom time (ie, before or after school)

Within contractual hours, DURING classroom time

Outside contractual hours

Other (please describe below):

To your knowledge, has similar training been done before?

YES

If yes, please describe.

15. If this project has a technology component, please confirm that the District's Director of Technology as approved this project, including any District required resources.

YES