Xenia Community Schools Foundation Grant Application
Applicant___________________________________________Position____________________________
School____________________________
Date______________________________
Project Title: ________________________________________________________________
Target Group: _______________________________________________________________
Number of Students to be served: __________
Statement of Need:
Project Description:
Objectives:
Timeline:
Evaluation Plan: (How will you determine whether your objectives have been achieved and whether your project has been successful?)
Itemized Costs:
Total Cost_______________
Applicant’s Signature___________________________________________
Date_________________________________________________________
Building Principal’s Signature__________________________________
Curriculum Supervisor’s Signature_____________________________
Grant Committee
Decision of Review Committee Approved__________ Not Approved________
Explanation:
Adjustments:
Chairperson_______________________________________________
Date____________________________
Form Updated: December 2013
