WORLD LANGUAGE TRIP Grant Request

Grant Payment Application

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* 1. Requestor Information

Your Name:

Your Title or Position:

Request Date:

Destination of Trip:

Dates of Travel:

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* 2. Student Beneficiary Information

Name:

Date of Birth:

Current Grade in School:

Grade at Time of Travel:

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* 3. Has the student earned a grade of "C" or better in all language courses for this trip?

Yes

No

By initialing here, I am verifying that I have personally checked all grades, and that they meet a "C" or above (Requestor, please initial):

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* 4. How many courses in this language will the student have taken prior to Trip departure?

One (1)

Two (2)

Three (3+) or more

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* 5. Please provide evidence (signed permission slip or letter granting permission) of parental support of student participation in World Language Trip.

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* 6. Please provide a copy of the student's valid passport, visa, or any other required travel documentation necessary to participate in this Trip. If travel documentation is not currently available, PCF will provide a determination letter for this grant request but will not release funds until a satisfactory review of documents can occur.