Special Grant Application

  • Registration and School Information

  • The main point of contact for the project.
  • In case the Primary Contact is unavailable.
  • Please provide the names and contact info of all additional teachers / staff with an active role in the project.
  • Please discuss your project’s mission – purpose, community, and desired impact. (200-350 words)
  • Select all that apply
  • Please provide a timeline for your project. Briefly describe key milestones and estimated cost to achieve each milestone (100-350 words)

  • Budget

    Add as many lines as required
  • Vendor Item Description Quantity Cost Sub-total Tax Shipping TotalActions
            
  • Do you anticipate a recurring funding need for the project (e.g., additional funding needed beyond current request)?
  • What are the potential additional costs beyond the current request for funding?

  • Disclosures

    To maintain our tax-exempt status EPAK is required to keep records of your relationship to EPAK board members, officers or donors.

  • Certification & Agreement

  • I certify that I am directly responsible for the application and use of these funds. If I am awarded this grant, I agree to:
    1. Use these funds for the purpose I have stated. Request permission in writing before making any changes.
    2. Send any requested milestone reports and a completion report with scans of original receipts.
    3. Return unused funds to EPAK or request in writing before using them.
    4. Leave all equipment, supplies and materials purchased with these funds with my school or institution if I leave so that students will continue to have the benefit of this grant.
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later