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Sample Impact Grant
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Ashland Schools Foundation
2004-2005
Impact Grant Application Form |
ASF USE ONLY
Grant #: _________
Date Rec’d: _______
Action: __________
Date:____________
Assigned to:
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Part A - Summary |
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1. Project Title: |
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School: |
Walker |
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2. Project Start Date: |
November 1, 2004 |
End Date: |
February 1, 2005 |
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3. Total amount requested: |
$ 250.00 |
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4. Name(s)
LEAD TEACHER: |
Grade / Subject (if app) |
Work Phone & Extension |
E-Mail
(if other than standard school email) |
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Morgan Cottle |
5 |
482-1516 x112 |
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ASSISTING TEACHERS: |
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Sharon Dvora |
Art |
482-1516 x131 |
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5. Brief Summary of the Project: |
*No more than 2-3 lines, you may expand your description in the next section. |
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Students will create a hand made tie-dyed quilt that will be donated to a local women’s shelter. The students will learn to dye, sew and quilt, as well as learn the value of giving to others in need within the community. The students will also create a tie-died T-shirt that they will be able to keep as a memento of this project |
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5. How many students will this project serve directly? |
27 |
Indirectly? |
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Ex: Students learn a skill (direct benefit) and then teach younger students in the school (indirect benefit.) |
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6. Which curricular area(s) does this project address? |
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X |
Math |
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Lang. Arts/World Lang. |
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Science |
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Health/PE |
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X |
Fine Arts |
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Professional / Technical |
X |
Soc.Studies/History |
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Additional Comments (if desired): |
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Along with math and fine arts, the students will also learn about our community, and how outreach programs affect those in need. |
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Part B – Grant Description |
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On no more than two pages, provide the following information: (Boxes will expand with your text)
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2. Explain how the project addresses the class or school-wide curricular goals. What is the enrichment objective you intend to address? |
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This project addresses the class and school wide goal of community involvement and giving. One of the over riding missions in the Walker community is to…. “develop lifelong learners in a nurturing environment, which focuses on self-esteem, interpersonal relationships, problem solving and self-expression.” This project allows the students to create individual works of art, knowing that it will become part of a larger project that will be donated to help the community. The enrichment objective is to develop a sense of community outreach and responsibility in our young students. I believe that this project will succeed in that objective.
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3. Describe the publicity/media opportunities that will occur during project activities. |
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I will document the progress of our quilt with our digital camera, and post the results on our website. I will also send out an invitation to the Daily Tidings with hopes that they will cover the donation of the quilt. |
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4. Explain how you will evaluate the success of the project. |
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I will evaluate the success of our project in many ways. First, I will carefully watch and assist the students while they learn how to tie-dye. I will be assisted with this by Sharon Dvora who has years of tie-dying experience. Next, with the help of local sewing experts, we will analyze how carefully the quilt is constructed. We will also have a presentation from the women’s shelter and will have a focus write from the students explaining what they have learned from that presentation. After the quilt is donated, the students will generate a statement about how their donation will benefit the shelter.
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5. Explain how, if at all, local community members will be involved in the project. |
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Local community involvement will include volunteer helpers who will help with the quilting in the classroom and leaders of the women’s shelter who will give a presentation to the class and accept the finished quilt. |
Part C – Applicant’s Signature |
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I hereby confirm that the grant application that
I have submitted meets the criteria of the
Ashland Schools Foundation and that I have
read and agree with the grant requirements. |
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Electronic Signature h |
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School |
Walker Elementary |
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Date: |
9/27/04 |
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Part D – Principal’s Concurrence |
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As Principal of |
Walker |
School |
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I hereby confirm that the grant application that
is submitted here meets the curriculum goals of
the school and has the concurrence of the
school administration and/or site council. |
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Electronic Signature h |
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School |
Walker Elementary School |
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Date: |
September 29, 2004 |
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APPLICATION DUE DATES:
Fall 2004: Wednesday, September 29, 2004, midnight
Spring 2005: Wednesday, January 26, 2005, midnight
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