EmailMe Form - Inspire Disaster Recovery Grant Application

School Data

School Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email

Web Site

Principal

First Last

School Librarian

First Last

Grade Level(s)

Current Enrollment

Displaced/Evacuee Enrollment

If Applicable

Public School?

Yes

No

NCES ID

School District Name

School District Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Applicant/Primary Contact

Name

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Fax

### - ### - ####

Email

Position:

Grant Coordinator

If different from Applicant/Primary Contact

Name

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Fax

### - ### - ####

Email

Position:

School Librarian

If neither the applicant nor the grant coordinator is a certified school librarian, please identify the certified school librarian who will be assisting with collection development.

Name

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Fax

### - ### - ####

Email

Grant Request

Type of Disaster (Choose One)

Grant Amount Requested:

Please provide a two-page narrative describing the disaster or hardship and how you will use the funds *

The following documentation is required with the two-page narrative: a project plan that includes a timeline, the number of students the grant will reach, a list of key staff involved in the grant plus a short biography of each, and an itemized budget.

Please indicate the type of state-certified school library professional you have in your school library program:

Full-Time State Certified School Librarian in Building

Part-Time State Certified School Librarian in Building

State Certified School Librarian at District Level

Please submit letter from school principal agreeing to submission of the Inspire Disaster Relief Fund.