Name __________________________________ Date _________________

Phone ______________________ Requested Amount _________________

Program / Area _________________________________________________

Purpose Of Request: (Please explain in detail - 3 pages maximum)

In your statement, please answer the following questions:

1. How will my project/request affect the over-all campus, my program and/or students?

2. What other means do I have to obtain funding?

3. Completion date of the project

4. Approval by site administrator

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Please attach additional pages

Approved For Submission:

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(Administrator’s Signature)

Deadline Date: May 15th To The District Administrator

FOUNDATION USE ONLY:

APPROVED ____________ DENIED ____________ DATE ____________

AMOUNT APPROVED $ ____________

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(Foundation Director Signature)