COVID-19 FUND - REQUEST FORM*

Today's Date

MM

DD

YYYY

Name of person making the request:

First Name

Last Name

Building (if applicable)

Email:

Best Contact Number:

(###)

###

####

Amount Requested

$

Date funds needed by:

MM

DD

YYYY

Explanation of what funds are for:

Is there a plan for sustainability? Please explain:

What other resources have been explored (School District, State, Government) and results:

Make check payable to:

Send payment to:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Principal Signature:

First Name

Last Name