Student Form

Student Grant Application 2021-22
(Please be sure to read over the types of qualifying programs.)
Due Date - Extended to Tuesday, May 4
(Valid for any activities that occur between
May 15, 2021 and May 14, 2022.)

NOTE: This form does NOT save work when closed! As a precaution, type your answers in a word processing application, save, and then copy and paste.

NOTE: If you require special assistance filling out this form, please see Jim Franko in Student Services.

Student Information

* Indicates required field

Name *

First

Last

Grade Level (Current seniors are not eligible to apply.) *

Freshman Sophomore Junior

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 help 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

Please give us the name of an RBHS sponsor or staff member as a character reference for you. (You do not need a letter of recommendation.) *

By checking below, I agree that I, a student of Riverside Brookfield High School, have completed this application myself. If it is found that I have falsified this statement, I acknowledge disqualification from all RBEF monetary awards. *

I Agree

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

Student Grant Application
DUE DATE - EXTENDED UNTIL Tuesday, MaY 4
NOTIFICATION - FRIDAY, MAY 7

Student Grant Application 2021-22
(Please be sure to read over the types of qualifying programs.)
Due Date - Extended to Tuesday, May 4
(Valid for any activities that occur between
May 15, 2021 and May 14, 2022.)

Student Information

Event/Class/Seminar Information

For What Purpose Will The Grant Be Used?

What Do You Hope To Learn And Accomplish From This Experience?

Expenses

Additional Funds

Request Information

By-Laws

Insurance 2020-2021.pdf

501(c)(3)

Student Grant Application DUE DATE - EXTENDED UNTIL Tuesday, MaY 4 NOTIFICATION - FRIDAY, MAY 7

Student Grant Application 2021-22(Please be sure to read over the types of qualifying programs.)Due Date - Extended to Tuesday, May 4(Valid for any activities that occur between​May 15, 2021 and May 14, 2022.)

Student Information

Event/Class/Seminar Information

For What Purpose Will The Grant Be Used?

What Do You Hope To Learn And Accomplish From This Experience?

Expenses

Additional Funds

Request Information

By-Laws

Insurance 2020-2021.pdf

501(c)(3)

Student Grant Application
DUE DATE - EXTENDED UNTIL Tuesday, MaY 4
NOTIFICATION - FRIDAY, MAY 7

Student Grant Application 2021-22
(Please be sure to read over the types of qualifying programs.)
Due Date - Extended to Tuesday, May 4
(Valid for any activities that occur between
May 15, 2021 and May 14, 2022.)