WORLD LANGUAGE TRIP Grant Request

Grant Payment Application

Question Title

* 1. Requestor Information

Your Name:

Your Title or Position:

Request Date:

Destination of Trip:

Dates of Travel:

Question Title

* 2. Student Beneficiary Information

Name:

Date of Birth:

Current Grade in School:

Grade at Time of Travel:

Question Title

* 3. Has the student earned a grade of "C" or better in all language courses for this trip?

Yes

No

By initialing here, I am verifying that I have personally checked all grades, and that they meet a "C" or above (Requestor, please initial):

Question Title

* 4. How many courses in this language will the student have taken prior to Trip departure?

One (1)

Two (2)

Three (3+) or more

Question Title

* 5. Please provide evidence (signed permission slip or letter granting permission) of parental support of student participation in World Language Trip.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Question Title

* 6. Please provide a copy of the student's valid passport, visa, or any other required travel documentation necessary to participate in this Trip. If travel documentation is not currently available, PCF will provide a determination letter for this grant request but will not release funds until a satisfactory review of documents can occur.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.