Grant Application

Please Note:

The deadline to submit your application is Wednesday April 11th at 12 noon.
Do not include school name in title. School identification anywhere except designated fields is cause for AUTOMATIC rejection of application.
This application form cannot be saved online. We suggest you have your project details ready; drafts can be done in Word, then copied and pasted into the form.
You will have a chance to review your application before completing the form.

Project Title

Lead Applicant

First Name

Last Name

Phone Number

School

Additional Applicants

	First Name	Last Name	Email	School
Applicant 2
Applicant 3
Applicant 4
Applicant 5

Is this an In-Residence Grant?

Yes No

Name of In-Resident

Email of In-Resident

Phone of In-Resident

Principal's Name

Project Category

If "Other", please explain

Number of Students

Project Description

Briefly describe the project you want to implement in your school and its innovative qualities. Detail what kind of activities will take place and how they will enhance learning.

Project Goals

Tell us what you hope to achieve with this project. Make objectives measurable, achievable and reasonable.

Project Timeline

What is the time frame or sequence of events for this project?

Project Evaluation

How will you measure the success of this project?

Budget

Budget requests: Detail your budget request. Organize the budget items according to project activities. Include kinds of materials and equipment needed, sources of supplies and cost. Be specific - list all known expenditures and estimate expenses yet to be determined. Enter zeros in cells that do not apply.

Technology Grants: This technology request has been selected from the guidelines found in the instructions. If not, I have received approval from Pat Drago. Yes No Not Applicable

Amount requested from the Foundation should not exceed $2000 for mini-grants and $3000 for in-residence grants.

	Amount from FWHPS	Amount from other sources
Books/materials	$ .00	$ .00
Equipment	$ .00	$ .00
Supplies	$ .00	$ .00
Honoraria for In-residence grants	$ .00	$ .00
Travel	$ .00	$ .00
Technology	$ .00	$ .00
Installation	$ .00	$ .00
Shipping	$ .00	$ .00
Other	$ .00	$ .00
Other (2)	$ .00	$ .00
Total:	$0.00	$0.00

I am applying for grant(s).

Would you be able to undertake this project with partial funding? Yes No

Funds will be available after September 1, 2012.

If you received a grant last year did you submit a Final Report? Yes No n/a

Grant last year: If you had a grant last year and did not submit a Final Report, please explain:

I agree to submit a Final Report to the Foundation for West Hartford Public Schools upon completion of the project or no later than June 3, 2013

I give the Foundation for West Hartford Public Schools the right to use this proposal and the results of this project for public information purposes.