Addendum
In
District Grant Fund Application
Name______________________________________________ Date
Address____________________________________________ Home Phone
___________________________________________________ School
Current Assignment___________________________________________ Licensed or ESP (must circle one)
Specific Description of Proposal:
Goals and Objectives to be accomplished:
Brief Statement of Personal/Professional Growth:
Benefit to the District:
You may attach additional information or a statement of reasons why you feel your request should be
granted.
Have you discussed this with your administrator? __________
Have funds been allocated from the
school budget? ___________ If you requested
monies from other sources indicate:
source __________________________________, amount received
_______________.
Expense Items Amount
___________________________________ _________
___________________________________ _________
FOR COMMITTTEE
USE ONLY
___________________________________ _________
___________________________________ _________
Total Request $ _________
Signature of Applicant