STUDENT Form

Grant Application

This form is for PHS Junior/Senior students to use when applying for a funding grant.

Parents: Please use the Families Form.

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* 1. Student Requestor Information

Student Full Legal Name:

Preferred Name or Nickname:

Student Email Address:

Did your family apply for Free- or Reduced-Price Lunch?

Current School:

Grade:

Guidance Counselor:

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* 2. Program/Activity Information

Name of Activity/Provider:

Program contact name:

Contact Email or Phone Number

Description of Program/Activity:

Start Date of Program:

Full Cost of Program:

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* 3. Have you or your family applied for financial aid through the provider?

Yes

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* 4. If yes, what is the adjusted cost?

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* 5. Have you asked another group or non-profit to cover the cost of this program?

Yes

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* 6. If Yes, who did you ask and how much did you ask for?

Name of Group/Non-Profit:

Amount Requested:

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* 7. Was your request approved?

Yes

STUDENT Form

Grant Application

Question Title

* 1. Student Requestor Information

Question Title

* 2. Program/Activity Information

Question Title

* 3. Have you or your family applied for financial aid through the provider?

Question Title

* 4. If yes, what is the adjusted cost?

Question Title

* 5. Have you asked another group or non-profit to cover the cost of this program?

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* 6. If Yes, who did you ask and how much did you ask for?

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* 7. Was your request approved?

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* 8. How much was it approved for?

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* 9. How much can you or your family contribute toward the cost?

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* 10. If there is any other information you would like to include with your application, please do so below: