Applicant: ______________________________________     Date: ____________________
 
Position: _______________________________________
 
Telephone: __________________e-mail:_______________________fax:_______________
 
Approval (Students only):  _____________________________________________________
     ( signature of Dean of Students or Faculty Club Sponsor)
 
Please describe your proposed project or event:   
 
___________________________________________________________________________
 
___________________________________________________________________________
 
___________________________________________________________________________
 
___________________________________________________________________________
 
Is this project/event included in your school/department/class/grade/club operating budget?     

What is the project/event's total budget?  $__________     Please attach a copy of the budget.
 
Funds requested from the Parents' Association:  $___________
 
 
1.  One or two key issue areas this proposal 2.  School constituency this proposal
     addresses:      would serve:
       
     _____  school community building      _____  students    (# ___________)
     _____  educational enhancement      _____  teachers    (# ___________)
     _____  parent education      _____  administration
     _____  community service      _____  staff
     _____  social skills      _____  parents
     _____  physical health      _____  school division or department
     _____  counseling / mental health                      (name ________________)
     _____  life skills     
     _____  arts / culture     
     _____  extra curricular activities
 

Please submit this form to:
     Within a school: submit to one of your PA School Council Co-Chairs
     Across schools: submit to the PA Treasurer
 
Please note, a final report and financial statement on how the grant was used is due within 30 days after completion of the project.