FINANCIAL ASSISTANCE APPLICATION FOR RPT EXAM PROGRAMS

Application Date:______

PART I.

Name of Chapter or AEB: ______

(Please use the same name that is on your chapter/AEB bank account)

Chapter Number:______

Contact Person:______Title:______

Address:______City/Town:______

State/Province:____ Zip/Postal code:______Phone Number(s):______

FAX:______Email ______

Check one: q Existing program q New program startup

Check all that apply: q Examiner travel/lodging expenses q Equipment purchase or maintenance

q Examiner training, certification or recertification expenses q Shipping of borrowed equipment

q Other (please describe):______

Amount requested: $______

On the back of this form or on a separate sheet of paper please describe specific plans for this grant and state the reasons why financial assistance is required. Also, please indicate how much you will contribute from your own resources (time and money) on the projected activity for which you are requesting financial assistance.

On average, how many exams does your program administer per year? (Use last 3 years as a sample.)

Full Tuning____ Full Technical____ Part 1 retakes – Tuning____ Partial retakes – Technical_____

PART II. Chapters only (AEBs, please skip to Part III):

How many members does your chapter have? RPTs_____ Associates______TOTAL:______

Does your chapter assess dues? q Yes q No If yes, what is the annual dues amount? $______

Does your chapter test RPT candidates from other chapters? q Yes q No

PART III. AEBs only (Chapters, please ignore this part):

How many chapters are in your normal service area?______

Approximately how many members do these chapters represent?______

Do any chapters in your service area administer their own exams? q Yes q No

Submitted by: (signature)______

Title: ______Date:______

Please submit to: Piano Technicians Guild, 4444 Forest Ave., Kansas City, KS 66106 • FAX: 913-432-9986

Form 200 - 02/10

Thank you for your application for the RPT Exam Grant Program. Below is additional information from the Exam Policy Manual about grant criteria and the processing of applications. Please contact your RVP if you have questions about preparing your proposal.

FINANCIAL ASSISTANCE FOR EXAM PROGRAMS

1. Funding Applicants

a.  RPT exam sponsors may apply for funding.

1) Application Form 200 shall be utilized by chapters and Area Exam Boards (AEBs) in making such requests.

2) Sponsors making application must designate a contact person who will be responsible for communicating the needs of the applying sponsor to ETSC and the PTG Board.

b.  Funding may be provided to assist existing programs or to help establish a new program.

c.  Funding requests should reflect a desire on the part of the sponsor concerned to share the liability of expenses incurred.

2. Application Process

a.  All requests must be for future events. No funds shall be disbursed for events in cases where application for grants was made after the corresponding event took place.

b.  Applications may be obtained from the Home Office or downloaded from the PTG website.

c.  Completed applications should be sent to the Home Office, and the date of receipt recorded on the form.

d.  A copy of the form shall be forwarded to ETSC for consideration.

e.  The ETSC shall discuss the application and clarify any questions pertaining to the needs outlined. The RVP and board liaison should become aware of the application through this deliberation.

f.  Recommendations from the ETSC shall be forwarded to the PTG Home Office who shall then forward all documentation to the PTG Executive Committee.

g.  The Executive Committee will affirm, reject, or modify the ETSC recommendation, and inform the applicant and the ETSC of the decision reached.

Form 200 - 02/10 • Page 2