Northland JC Foundation

2012 Academic Fellowship Grant

Grant Application

Purpose: The purpose of the NJCF Fellowship Grant is to provide a resource for teachers / administrators to apply, to subsidize special projects / programs that may not be covered in the normal operating budget.

Guidelines: Applications must be received by the NJCF no later than May 1, 2012, for the 2011-12 academic years. Selection and notification will be made no less than 30 days prior to the start of the semester in which the program will be implemented. Applications are to be submitted to the Northland JC Foundation, Academic Fellowship Grant Committee at 6300 N. Indiana, Gladstone,, MO 64119. A maximum grant of $1,000.00 will be awarded. For further information, contact David Page at (816) 436-1555 or DPagekcmo@aol.com.

Applicant Information

School name: _________________   District: _________ Date submitted: ________

School Address: _______________________________________________________

(Street City State Zip code)

Project Name: _________________________________________________________

Sponsor’s Name: _________________ E-mail address: _______________________

Business phone Fax #: P____________________, F ________________________

Fellowship granted or denied (summer) contact information if different from above:

_______________________________________________________________________

Course / Class name Curriculum Category: __________________________________

Date of program or semester(s) of study: ___________________________________

Specific request (amount:  ________

Number of people to be impacted: ________

Date program would be implemented: __________________

Date program would complete: _______________________

            Date funds would be needed: _________________

Program Description & Planning Guide

(Attach additional sheets as needed)

1. Primary purpose for conducting this project or program?

2. Provide a brief description of the proposed project including background     information.

3. What are the specific goals and objectives to be achieved? How do they relate to the curriculum master plan?

4. What are the specific manpower assignments? (Show titles and duties.)

5. What specific materials, supplies, and resources will be required?

6. Describe the potential problems and solutions to successfully complete this project.

7. Complete a proposed budget indicating all anticipated income and expense. (Use separate sheet)

8. List the specific steps to bring this project to a successful completion showing planned dates for each step.

9. Describe how program, or individual(s), involved or affected, will benefit from conducting this proposal.

If awarded the fellowship, I, the undersigned, agree to allow the Northland JC Foundation to use any pertinent information in the promotion of the NJCF without additional compensation and to provide such agency with follow-up information regarding the use of the funds. Additionally, I agree that all information provided is true and complete.

Signature of applicant X _____________________________ Date __________