Student Form

Student Grant Application 2017

NOTE: This form does NOT save work when closed! We recommend you type it in a word processing application, then copy and paste it over.

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

Student Information

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 this will help you and/or the RB community? *

Expenses

Please list all expenses you expect to incur. Checks will be made payable to the organization or group sponsoring your requested grant.

Travel *

Lodging *

Meals *

Registration Fee *

Expenses You Expect To Incur *

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

In addition to this form, students are also responsible for getting a letter of recommendation from a RBHS sponsor or staff member emailed directly to or submitted in a sealed envelope to Jim Franko in Student Services. Please indicate in the following box from whom you will be getting a recommendation letter. *

By checking this 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 understand that I will interviewed and also commit to working the phone bank at the 2018 Telethon. *

I Understand

Submit Application

Student Grant Application