Water Education Mini-Grant Application

Payment must be made directly to the school, the supplier, the bus service, etc. A W-9 must be received prior to payment. Please fax completed W-9 to 892-0041.
* Required
* Teacher Name(s):  
   
   
   
   
* Primary Contact:  
* School:  
* Address:  
* City:  
* State:  
* Zip Code:  
* Contact E-mail:  
* Phone Number:  
* Fax:  
* Items Being Purchased:  
  How many students will be served by this grant?
* Student Count:  
  How did you hear about the water education mini-grant?
* Source:  
  How will the students use them?
* Use:  
  Enter a maximum of $500.00.
* Amount Requested:  
* Check Payable To: