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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.)
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