AZ/NASA SPACE GRANT/UA COOPERATIVE EXTENSION MINI-GRANT APPLICATION
Complete and return this form with appended project proposal/description
Applications are accept year round


PROPOSER INFORMATION:

			
Name	Home Address	City/State/Zip	Phone
			
School/Organization	School Address	City/State/Zip	Phone
			
Project Title		Is this a Globe or Project Astro-related project?	
Project for grade(s)
			
E-mail	Name of School District		U.S. Congressional District

PROPOSED BUDGET (add more pages as needed)

ITEM	DESCRIPTION	COST
Example	3-D Glasses, 50 pairs 	$25.00
1.		
2.		
3.		
4.		
5.		
TOTAL FUNDING REQUESTED FROM SPACE GRANT (up to $400)	
TOTAL FUNDING FROM  MATCHING FUNDS	
TOTAL COST OF PROJECT	
Space Grant funds must be 100% matched with non-federal funds.  
"In kind" cost share acceptable. Please call Space Grant Program Manager 
Susan Brew@ 520-621-8556 with questions or problems relating to cost share. 

Name matching funds source:   Is matching funds source a:        
?  business/industry                         ?  nonprofit organization                         
?  other

NUMBERS OF STUDENTS, TEACHERS, AND ADMINISTRATORS SERVED BY PROJECT 
(We are required to report this information to NASA):

	Caucasian	African American	Hispanic	
Native American	Pacific Islander	Other	Disabled	Total
Male Student								
Female Student								
Male Teacher/Admin								
Female Teacher/Admin								
Total								

Applications are especially encouraged for projects in schools/under-served 
areas of Arizona with greatest economic need.  Please note whether your school 
or group serves high percentages of underrepresented minority and/or economically 
disadvantaged students qualifying for free lunch programs, is a reservation school, 
has a special study focus of curriculum, etc. 
__________________________________________________________________________________
__________________________________________________________________________________

If awarded, I agree to provide the Space Grant Program a short summary report and 
photos within 30 days of completion of project activities.  I have read and 
support this proposal:

___________________________			____________________________
Teacher signature and date			Principal signature and date