Your Name (required)

Your Email (please use your


Position or Title

School(s) receiving funds select all that apply

Is this a joint application? yesno

Co-Applicant Name

Co-Applicant Email

Project Title

What is the nature of your project?

*if other please expand here

Project Objectives (please be specific)

How many of those with special needs will be served by or benefit from this project?
1-1011-2525-5050-100100+District Wide

What is your timeline?Immediatewithin 3 MonthsAnytime

Are there other funding sources for this project? yesno

Has this project been approved by your administrator? yesno

Budget requested (up to $750) please include breakdown of expenses

Is there anything you would like to add or any special considerations?