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 $500) please include breakdown of expenses

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