MEEMIC Ins. Co. - Foundation Application

The MEEMIC Foundation for the Future of Education
Grant Application for Michigan Educators

Applications are being accepted now for FALL SEMESTER 2011 funding. The deadline for submitting grant applications will be April 30, 2011. All applicants will be notified by mail by the end of May 2011.

Educator's Name: *
Educator's Email Address: *
School Name: *
School Address: *
City: *
State: *
Zip Code: *
County: *
School Telephone Number: *
School Fax Number:
Principal/Department Chairperson’s Name: *
Principal/Department Chairperson’s email address:
Name of MEEMIC Agent Active in Your School:
How did you find out about the MEEMIC Foundation: *
Select the Curriculum for your program: *:

1. Goal of the Program:

a. Please explain your program idea. *

b. How will this enhance classroom instruction? *

c. How will students benefit? *

d. Is there a student demand for this activity? *

e. How many students will be inpacted by this program ? *

2 . Project/Program Specifics:

a. Who will be involved in this program? *

b. How long will the program last? *

c. Can the program be reproduced with little or no cost in the future? *

d. What adjectives would best describe the program or its effects? *

3. Results and Evaluation:

a. What results do you anticipate? *

b. How are the outcomes measurable? *

c. Are there any foreseeable problems with this plan? *

d. How could they be prevented, or how could the plan be changed for the future? *

4. Program Budget:

Please state the amount you are requesting and itemize the project costs. Please identify all other sources of funding (donations, school fundraisers, classroom budget, other grants). Please note that grant writers who have sought additional or alternate sources of funding for their programs will be highly-regarded.

Itemized Costs (materials, supplies, software, etc.)

Description *	Amount * (No commas)
	$
	$
Please list any additional program budget details and amounts below:
Funding from Additional Sources
Description	Amount (No commas)
	$
	$
Please list any additional funding sources and amounts below:

Grant Amount Requested from the MEEMIC Foundation: * $

(*) Denotes a required field.

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