Pi Chapter PROFESSIONAL DEVELOPMENT

GRANT APPLICATION FORM

NAME DATE

Phone Email

PROFESSIONAL DEVELOPMENT TITLE

Subject Area(s) of Project

Project Site

Amount Requested

PROJECT DESCRIPTION

Attach a description of your project, stating as specifically as possible its purpose, needs, goals, objectives,
where, when, and under what conditions activities will take place.

Project time-line

PROJECT RESULTS

What specific results will this project have for students?

How will you measure these results?

BUDGET

Attach a proposed budget with item descriptions and costs.

Can the project be completed if it is only partially funded?

If so, please prioritize budgeted items to indicate which are essential, and which could be otherwise supplied, or
will not jeopardize the project, if funding were not available.

SUBMISSION

Submit your completed application to Barbara Carruth at jccbsc@gmail.com or 5601Winterberry Ct., Dayton, OH
45431-2814. (Electronic submission preferred.)

Application is available any time. (Allow one month from application dates to notification of acceptance for
funding.)

CERTIFICATION I certify
 that I have been a member of Pi Chapter of Delta Kappa Gamma Society International for at least 2 years;
 that I have attended at least 3 meetings a year; and,
 that after the completion of the project I will give a report at a Pi Chapter meeting describing the project
and its outcomes.
(Signature)

(Typed name is accepted on an electronic submission.)