IAHPERD Grant Application

Project Title *

Amount Requested *

Date of Application *

Name of Applicant(s) (Must be an IAHPERD members for 2 consecutive years) *

Position(s) *

Name of School/Agency *

School's Tax exempt ID number *

Name of School/ Agency *

Email Address *

Home Phone *

Work Phone *

School's Mailing Address *

Name of Principal/ Administrator *

Signature of Principal/ Administrator *

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Provide a summary description of your proposed project. *

State the project objectives/ goals. *

Describe how this project will meet the needs of children/ students. *

Describe how this project will enhance the mission/strategic plan of IAHPERD. *

Approximately, how many children/students will be targeted by the proposed project? *

How will you measure project goals and objectives to determine the projects? *

If total of amount is not received, where will remaining funds, if necessary come from? *

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. *