1. Primary Applicant Name *

First Name

Last Name

5. PTA Member *

Is primary applicant or co-applicants a Wedgwood PTA member?

Yes

No

6. How many other PTA application grants have you been awarded this year? *

0

1

2+

7. Does the PTA give you a stipend? All teachers, interventionists, nurse, and social worker have stipends, and should answer this question "Yes". *

Contact the PTA Treasurer if you are unsure if you have a stipend.

Yes

No

Unsure

8. Is your position funded but the PTA staffing grant? *

The PTA staffing grant are PTA-supported salaries with funds distributed by the district.

Yes

No

Unsure

11. Funding Level *

Partial funding OK

Full funding ONLY

13. Beneficiaries *

Who does this project directly serve?

Students

Families

Staff

Other - explain in project description below.

14. Number of Students Served *

Less than 15 students

16 to 35 students (approximately 1 class)

36 to 89 students (approximately 1 grade)

90 to 179 students (1-3 grades)

More than 180 students (more than half the school)

15. Funding Bands Alignment *

Does the amount requested align with the suggested funding bands? For 1-35 (~1 class) served, suggested funding: Less than $249 For 36-89 (~1 grade), suggested funding: Up to $749 For 90-179 (~2 grades), suggested funding: Up to $1499 For 180 or more students (>3 grades), suggested funding: Up to $2500 If your project does not align with these bands, explain why it should be funded in the project details.

Yes

No

20. Longevity *

What best describes your project and the items purchased for it?

Use a limited number of times this school year.

Use recurrently throughout this school year.

Use recurrently over several school years.

21. Including Attachments *

Send all attachments in ONE EMAIL to grants@wedgwoodpta.org

Yes

No

22. Align with PTA Mission & Vision *

Yes

No

23. Grant Awardee Agreement *

Funds will not be used for the following: To replace emergency funds, scholarships, professional development, transportation, facilities modifications, or staff salaries. Keep receipts for related purchases for reimbursement; or arrange for direct payment prior to purchasing. A brief description of stipends and awarded grants will be posted to the PTA website. All items purchased via classroom stipend or grant funds remain property of Wedgwood Elementary. All purchases must be completed by the last day of school. Notification of Building Leadership Team by the PTA that the award was granted. Upon request, submit a report to the PTA with updates of project results, outcomes, and photos.

I agree.