Official Use Only

Grant #

Check # 16-714 [email protected] [email protected] [email protected] An affiliate of the Kamehameha Schools

Date:

ENRICHMENT GRANT APPLICATION # Participants

(Attach list for clubs/groups) Address:

Date

Contact Telephone #:

Activity: (check which one applies) ______Athletic

______Academic ______Club ______Grade Level

Other: Date(s) of Event:

Location:

Organization Sponsoring Event: Purpose:

This request for PTO Enrichment funds is made with the understanding that all recipi ents will assist in a PTO event as assigned. This application will only be reviewed when the Give-Back commitment part of the application has been completed and attached to the Grant Application. Club/Class Advisor must be present at the time of Give-Back commitment. List Enrichment Grants and amounts approved and/or received this current school year: Estimated Income per STUDENT

Estimated Expenses per STUDENT

Parent: Club: Fundraising: Donations: Other: Total Income:

Transportation: Lodging: Food: Fees / Tuition: Other: Total Expense:

$ $ $ $ $ $

$ $ $ $ $ $

Total Request: $

X =$ Per STUDENT* No. of Students Total Amount Requested *REFER TO GUIDELINES FOR MAXIMUM PER STUDENT FOR REQUEST

Signatures: Student:

Parent:

Advisor / Coach:

Principal:

Date:

Phone #:

Date:

Phone #:

*Make Check Payable To: (Official Use Only, do not write below this line)

Grant Approved By:

(PTO Executive Board)

Amount: $

Date:

16-714 [email protected] [email protected] [email protected] An affiliate of the Kamehameha Schools

ENRICHMENT GRANT AWARD RECEIPT

Contact phone:

Contact email:

Check Payable to: Name of Event: Purpose of Award:

( ) Educational

( ) Transportation

( ) Registration

( ) Other

Date of Event: Amount of Request: (Please complete the information above. Below to be completed by PTO Board Treasurer

copy to be retained by recipient)

Total Awarded: Number of students: Date: Check Number:

Check Amount: $

Date of Check: Approved By:

Date: Date:

Kamehameha Schools Hawai‘i Parent Teacher ‘Ohana (PTO)

SY 2017-2018 Grant Application Dates August 10, 2017 September 14, 2017 October 12, 2017 November 9, 2017 December 7, 2017 January 18, 2018 February 8, 2018 March 8, 2018 April 12, 2018 May 10, 2018