Music Grant Request Form 26 - Region 1 - v2 "*" indicates required fields RegionStateMusic Teacher ("Grantee")NOTE: You MUST be a public middle school teacher to apply for and receive this Grant.Your Full Name*Preferred phone number*Your Personal School Email Address* Note: It is critical that you set up the domain @prmfoundation.org as a “safe sender” prior to submitting this Grant Request Form. An automated “Confirmation” email will be sent to the school email address you provided by the Foundation immediately following your Grant Request submission. If this email is undeliverable and/or your acknowledgement response is not promptly received by the Foundation, your Grant Request cannot be processed. Alternate Email Address What types of music do you teach at your school? (Band, Choir, General Music, Orchestra, etc.)*Have you or your school received a Peter R. Marsh Foundation Middle School Music Grant in a previous school year?* Yes No New Applicants: How or where did you learn about this Middle School Music Grant program? Please be specific:*Middle School and Music Program InformationSchool District Name*Middle School FULL Name*NOTE: Grant checks are made payable to your school. However, if your school or district requires checks to be made payable to the district instead, please enter the official district name here:School Phone*Principal’s Name*Secretary/Administrative Assistant’s Name*Secretary/Administrative Assistant’s Email* Middle School Website Address (if none, provide District Website Address)*School USPS Mailing Address*NOTE: To avoid lost or delayed Grant checks, PLEASE VERIFY the appropriate USPS mailing address with your school administration. Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State ZIP Code What date does your current academic year begin?* MM slash DD slash YYYY What date does your current academic year end?* MM slash DD slash YYYY Estimated total number of students in all middle school grades at your school?*Approximately how many students will you teach in your middle school music class(es) at this school?*GRANT PROPOSAL & PROGRAM COMMITMENTPLEASE NOTE: Nationwide, many hundreds of Grant Requests are received and awarded annually by the Foundation. To include some of the teachers who may otherwise be denied a Grant due to the Foundations’ budgetary constraints, all applying teachers are encouraged to limit their funding request to meaningful needs only. Based upon the meaningful needs of your music program, you can apply below for a Grant of any amount up to a maximum of $1,850.00. The Grant funds can only be used for the items shown:Instruments, Instrument Repair, and Accessories: Student Transportation to Senior Facilities (3X): Music & Curriculum, Workbooks, Consumables, Classroom Supplies: Performance Equipment Materials and Attire: MY TOTAL GRANT AMOUNT REQUESTED IS: Will you provide a minimum of three (3) musical and visitation engagements with senior audiences?* Yes No Required element. Please apply when achievable.The nurturing of empathy and compassion in students through post-performance student/senior visitations is a required component of this Grant Program. Will this be accomplished at each performance?* Yes No Required element. Please apply when achievable.Is it your intent to incorporate the maximum number of your students, grades 5-9 only, in the senior engagements – either as musicians or observers?* Yes No Are you familiar with the Music Grant Reviews and Frequently Asked Questions?*View Music Grant Reviews and Frequently Asked Questions. Yes No CERTIFICATIONBEFORE SUBMITTING: Please review ALL of your entries carefully as errors and omissions will delay or defeat your desire to acquire a Grant. If you do not receive an automated confirmation email within 24 hours of your submittal of this form, please contact your Program Administrator directly at jgreco@prmfoundation.org or mpeper@prmfoundation.org. Comments, if any (optional)
