Project Funding Request Form – NEXT Steps Youth Entrepreneur Program

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Project Funding Request Form
Service-Learning Projects • Skillcoin Rewards™ Redemption
Complete the forms below to request funding assistance for a service-learning project or to redeem Skillcoin Rewards™.

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NOTICE: Redeemed Skillcoin Rewards™ must follow our 30/40/30 sponsorship allocation guidelines

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Project Information
Today's Date
MM slash DD slash YYYY
Project Name
Host Organization
Provide the name of the Partner In Education hosting the service-learning project.
Location of Service-Learning Project
Provide name of school or facility where your Operation Restoration service-learning activity or event will take place.

Street Address Address Line 2 City State ZIP Code
Your JEM Team Name
Provide the name of the JEM Team registered with this service-learning project.
List the names of your JEM Team leaders and their positions
First Name Last Name JEM Team Position Email Address Phone/Text

Click the + sign at the end of the row to add more spaces.
List the names of your STEM Mentors, Group Leaders, Teachers or Counselors that are helping you with your service-learning project.
First Name Last Name Partner Role Email Address Phone/Text

Click the + sign at the end of the row to add more spaces.
Disbursement Request Information
Request Date
MM slash DD slash YYYY
Name*
Please provide the following contact information for the person responsible for receiving the funding request.
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
PayPal Email Address*
Enter Email Confirm Email

All funds will be disbursed through PayPal
Total Amount Requested
Itemize what the requested funds will be used for.
Item Name Purpose/Use Unit Cost Number of Units Total Cost

Click the + sign at the end of the row to add more spaces.
Categorize your expense types (select all that apply)
- Service Contracts
- Food/Beverage
- Equipment
- Speaker Fees
- Stipends
- Supplies
- Training
- Travel
- Other (describe below)
Use this space below to provide more details about your funding request.
Use this space below to provide more details about your funding request.
Describe how this funding or these purchases will be used to support your service-learning project:.*
Upload any files that will support your request.
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
Signature
CERTIFICATION

I hereby certify that the requested expenditure is: 1) used to support the service-goals of our service-learning project for Operation Restoration; 2) directly related to the service-goals described on the fundraising campaign page of our service-learning project; 3) necessary and reasonable for the performance of the fund request; and, 4) drawn against available funding (if any) raised from sponsorships of digital badges directly related to our service-learning project. 5) considered a grant from our Project Fund and will reduce the total balance of the Project Fund for our service-learning project.
Electronic Signature of Authorized JEM Team member
Signature Date
MM slash DD slash YYYY

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First Name	Last Name	JEM Team Position	Email Address	Phone/Text

First Name	Last Name	Partner Role	Email Address	Phone/Text

Item Name	Purpose/Use	Unit Cost	Number of Units	Total Cost

Project Information

Disbursement Request Information

Signature

CREATE!