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STUDENT Form
Grant Application
This form is for PHS Junior/Senior students to use when applying for a funding grant.
Parents: Please use the Families Form.
*
1.
Student Requestor
Information
(Required.)
Student Full Legal Name:
Preferred Name or Nickname:
Student Email Address:
Did your family apply for Free- or Reduced-Price Lunch?
Current School:
Grade:
Guidance Counselor:
*
2.
Program/Activity
Information
(Required.)
Name of Activity/Provider:
Program contact name:
Contact Email or Phone Number
Description of Program/Activity:
Start Date of Program:
Full Cost of Program:
*
3.
Have you or your family applied for financial aid through the provider?
(Required.)
Yes
No
*
4.
If yes, what is the adjusted cost?
(Required.)
*
5.
Have you asked another group or non-profit to cover the cost of this program?
(Required.)
Yes
No
6.
If Yes, who did you ask and how much did you ask for?
Name of Group/Non-Profit:
Amount Requested:
7.
Was your request approved?
Yes
No
8.
How much was it approved for?
*
9.
How much can you or your family contribute toward the cost?
(Required.)
10.
If there is any other information you would like to include with your application, please do so below:
