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.