Pathways Club Grant Grant Request Form "*" indicates required fields WARNING: Responses to the following questions generated by artificial intelligence or other source or person other than the Club Leader will disqualify future grant applications!School InformationSchool Name*Is this a public school which participates in the federal 40% low income ESEA Title 1 program?* Yes No Have you or your school received a Peter R. Marsh Foundation High School Pathways Club Grant in a previous school year?* Yes No What dates are your first and last days of school for this school year?*School USPS Mailing Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code School FED-EX & UPS Mailing Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code By default, Grant checks are made payable to your school. If your school requires checks to be made payable to the district instead, enter the district name here:Club LeaderClub Leader Name*SalutationMr.Mrs.MissMs.Club Leader Email Address* Club Leader Phone Number*Phone Number Type* School Phone Cell Phone Club Leader School Employment Title*Club Leader Off-Campus/Personal Email:* School Administrator (or designee)School Administrator Name*SalutationMr.Mrs.MissMs.School Phone Number*Cell Phone NumberSchool Administrator Email Address* QuestionsWARNING: Responses to the following questions generated by artificial intelligence or other source or person other than the Club Leader will disqualify future grant applications!Where did you hear about this program?*The name “Pathways Club” must be utilized. Can you commit to specifically using the name Pathways Club?* Yes No Without exception, the Pathways Club must be maintained independently from all other school clubs and activities. Can this be accomplished in your school?* Yes No Will you strictly adhere to the Guidelines and Conditions?*“This Club changes lives when the Guidelines and Conditions of the Grant are followed.” - Teacher quote Yes No Can you commit to arranging, leading, and supervising the collective Club members in 2 or more off-campus community-service activities encompassing 10 hours of student service?* Yes No If no, please explain.*Only trauma-impacted students qualify for Pathways Club membership. How will you recruit the students, selected by your administration, to participate in the Pathways Club?*Club Members deal with perpetual adversity. How will you inspire them to remain engaged and prevent drop-outs?*The most-critical responsibility of a Club Leader is to ensure that the students are exposed to observable recognitions for their community service. Can and will you arrange for your student Club-members to be significantly recognized in both their community and in their school?* Yes No What has motivated you to become a leader of these at-risk students?*Will you photograph the student community service activities and the award presentation, and disclose the recognitions bestowed upon the students, all for inclusion in the year-end Activities Report provided by the Foundation?* Yes No Do you have any further questions or concerns about this program or your ability to comply with the Guidelines and Conditions of this Grant?* Yes, I have read, understand, and accept the eligibility requirements and conditions of this Pathways Club Grant.Important Notation: The Foundation will immediately confirm the receipt of your Grant Request via email. If this email is “undeliverable” or diverted by your school’s server, or if the Grant applicant does not respond to this email as requested, your Grant Request cannot be considered until communication is established. CONTACT AND QUESTIONS Program Administrator: Michelle Lancaster mlancaster@prmfoundation.org
