Please complete and submit this form to the Department of Education, Ithaca College.
Your Name Today's Date Dollar amount requested Your e-mail address School School Phone Ithaca College participant(s) NOTE: An Ithaca College participant must be involved
Please write a brief description of how these grant funds will be used - e.g., purchase of instructional materials. Partnership start date Partnership end date
I UNDERSTAND THAT GRANT FUNDS MAY NOT BE USED FOR SALARY PURPOSES. Please type in your full name, initials, and date in the boxes provided. Full Name Initials Date
Full Name Initials Date
