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Staff Grant Application
Due Date - extended to Tuesday, May 4
Notifications - friday, May 7
Staff Grant Application
NOTE: This form does
NOT
save work when closed! As a precaution, type everything in a word processing application, save, and then copy and paste to this application.
Information
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Event/Class/Seminar Information
Program Name
*
Program Location
*
Line 1
Line 2
City
State
Zip Code
Country
Program Website (If Available)
*
Registration Deadline Date
*
Program Start Date
*
Program End Date
*
For What Purpose Will The Grant Be Used?
To ensure full consideration all supporting information is required such as brochure, website, camp application form, outlining the event/program/camp and costs.
*
What Do You Hope To Learn And Accomplish From This Experience?
Be detailed : How will this activity benefit you and/or the RB community?
*
Expenses
Please list all expenses you expect to incur.
Travel
*
Lodging
*
Meals
*
Registration Fee
*
Miscellaneous Expenses
*
TOTAL
*
Additional Funds
Have you secured funds from other sources?
*
What is your contribution? (If $0, please explain.)
*
Request Information
Amount you are requesting from the RBEF?
*
Payment Option
*
Please pay organization directly.
Please pay grant recipient directly (To be reimbursed, confirmed registration AND receipts for expenses are required).
Based on payment option, include the appropriate address
*
Line 1
Line 2
City
State
Zip Code
Country
If I am awarded a grant, I commit to being interviewed and also working the phone bank at the 2022 Telethon. (Most likely, next year's telethon will take place on Saturday, March 5 or 12 of 2022, so please mark your calendar now as a reminder.)
*
I understand.
Submit Application