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Date:

Zip:

State:

Ezra Jack Keats Foundation Minigrant Application

PLEASE READ THE MINIGRANT INSTRUCTIONS BEFORE YOU BEGIN. (Failure to follow the instructions will disqualify your application.)

Review the application and have all your information ready to enter. There is no time limit. However, your information will NOT be saved if you close an incomplete form.

Contact and Organization Information

Organization Name:

Type of Organization:

Public School Public Library

Mailing Address:

Organization Email Address:

Principal / Library Director:

Contact Name and Title:

Telephone:

() -

Email Address:

Briefly describe the geographic location and composition of the population your library serves.

About Your Program

What is the name of the proposed program?

Is this a new program?

Yes No

... if no, how was it funded in the past?

Describe in detail the program activities, including how the students, educators and caregivers will be participating.

How does this program go beyond the basic curriculum?

Structure of the Proposed Program

Number of sessions:

Length of each session:

How often will sessions be held?

Program Resources

How many children do you expect to participate?

How many caregivers?

How many other participants?

Has your organization received an EJK Minigrant in the past?

No Yes

... if yes, for what year?

Cost of Program

REMEMBER IT'S ABOUT THE PROGRAM. Grants will not be awarded for the purchase of book or technical equipment, salaries or activities that are a normal part of the curriculum.

Please specify the materials and costs not to exceed $500

Name of Material

Cost per unit

Units needed

Total

Please specify the TOTAL COST of your program:

Will your program be exclusively funded by the EJK Minigrant?

Yes No

Agreement

I understand that this project must be COMPLETELY and EXCLUSIVELY funded by the EJK Minigrant, and that no other funds will be used for the program. The Foundation will request the return of funds for failure to comply with these guidelines.

If this proposal is accepted, I give permission for my final report to be used in publicity, articles or presentations, online and in print. My name and the name of the organization will be attached wherever the report is posted.

I confirm that I belong to the organization named above and will use the funds awarded for the educational program herein described.

To agree to these terms, please enter your initials: and today's date: