Educator Grant Application

First Name:
Last Name:

(Optional)
    Address:
    City:
    State:
    Zipcode:

Daytime Phone Number:
Evening Phone Number:
Email Address:
School:
Position:
Grade Level:
Principal / Director Name:
Principal / Director Email:

Budget (must support your project description and educational objectives)

Vendor Item Description Content Area Quantity Cost/Item Sub-Total

Disclosure

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

I am related to      in this way:   

I am an EPAK board member.

I am not related to any EPAK board members, officers, or donors.


Certification and Agreement

I certify that I am directly responsible for the application for and use of these funds. If I am awarded this grant, I agree that I will:

  1. Use these funds for the purpose I have stated.
  2. Request permission in writing before making any changes.
  3. Send this post project report and original receipts on an 8.5 x 11 paper, labeled, and tallied using the table.
  4. Return unused funds to EPAK or request in writing before using them.
  5. Leave any books, equipment, and materials purchased with these funds with my school or institution if I leave so that the children will continue to have the benefit of this grant.
  6. Not apply again until all receipts from prior projects have been sent in.

  I agree to these terms.