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Project Title
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Amount Requested
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Date of Application
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Name of Applicant(s) (Must be an IAHPERD members for 2 consecutive years)
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Position(s)
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Name of School/Agency
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School's Tax exempt ID number
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Name of School/ Agency
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Email Address
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Home Phone
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Work Phone
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School's Mailing Address
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Name of Principal/ Administrator
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Signature of Principal/ Administrator
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Provide a summary description of your proposed project.
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State the project objectives/ goals.
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Describe how this project will meet the needs of children/ students.
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Describe how this project will enhance the mission/strategic plan of IAHPERD.
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Approximately, how many children/students will be targeted by the proposed project?
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How will you measure project goals and objectives to determine the projects?
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If total of amount is not received, where will remaining funds, if necessary come from?
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Detail your budget request. Use a separate page if necessary. List specific brands, descriptions, quantities, catalog or part numbers, shipping, etc. Include any estimates, if necessary.
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