Maine Agriculture in the Classroom Council

Maine Agriculture in the Classroom Council

Grant Program Cover Form 2017

PROJECT NAME ________________________________________________________

PROJECT

DIRECTOR____________________________________PHONE___________________

HOME ADDRESS ________________________________________________________

CITY_________________________________________ZIP CODE_________________

E-MAIL ADDRESS________________________________________________________

*SCHOOL OR ORGANIZATION______________________________________________

*ADDRESS______________________________________________________________

*CITY________________________________________ZIP CODE__________________

TAX ID NUMBER_____________________501(c)(3) Number______________________

GRANT CATEGORY_- □ Ag Leadership (up to $1,000)

(Choose one) □ Ag Awareness (up to $1,000)

□ School Garden & Greenhouse (up to $3,000)

□ Ag Awareness (up to $3,000)

FUNDS REQUESTED__________________NO. OF STUDENTS IMPACTED_________

HOW OFTEN AND/OR HOW LONG ARE STUDENTS ENGAGED?_________________________________

CO-PROJECT DIRECTOR (S)_______________________________________________

_______________________________________________________________________

_______________________________________________________________________

By signing and submitting this proposal the applicant(s) certifies that the information contained herein is true and complete to the best of his or her knowledge and accepts the obligation to comply with the terms and conditions of the Maine Agriculture in the Classroom Council in effect at the time of the award. Unsigned applications will not be considered. *Grant checks will be written and mailed to the school or organization above unless arrangements have been previously approved by the grant administrator.

SIGNATURE OF PROJECT DIRECTOR DATE

SIGNATURE OF C0-PROJECT DIRECTOR(S) DATE