Contact Name *

Contact Email *

Contact Home or Cell Phone *

School Name *

Teachers Partnering in Project *

Partner Teachers Emails

Project Name *

Dollar Amount Requested (must be between $100 - $1000): *

Co-Funded Dollar Amount

Co-Funded By (if applicable)

Subject area of project (i.e.Math, Reading, Music, Science, etc) *

Grade(s) of students affected by project *

Number of students affected by project *

Project Description [Should include: Purpose of project. What specifically do you plan to do? How will students benefit? Who will be involved in the project? How is the project creative/innovative?] *

Purchase Description [What specifically would the grant $$ be used for? What will be purchased? How many will be purchased?] *

Measurement [How will you measure the impact of this project on student achievement?] *