Public Education Foundation of Little Rock

Pre-Application Form (each field is required)

Project Title

Primary Applicant Information

Contact Name

Email Address

Phone - Wk

Phone - Hm

Fax Number

Name all applicants associated with this proposal

School (LRSD)

Principal of School

Teaching Assignment of Primary Applicant

Grade
Subject


Estimated Project Implementation Date	(Click calendar to select a date.)
Estimated Project Completion Date	(Click calendar to select a date.)
Total Grant Request	$ (no dollar signs or commas, please)
Total In-kind Donations	$ (no dollar signs or commas, please)
Total Project Budget	$ (no dollar signs or commas, please)

If funded, will your proposal target specific student groups? If yes, please select which one.

If funded, will your proposal encourage participation by gender or race?

Proposal addresses children in the following grade levels (hold Ctrl key to make multiple selections).

Proposal addresses the following discipline (select one).

	Business and Marketing Education		Social Studies
	English/Language Arts		Computer Science
	Career and Technical Education		Foreign Language
	Science		Physical Education
	Career Training		Core Curriculum
	Music		Health Education
	Visual Art		Creative Writing
	Drama		Family and Consumer Science
	Dance		Self Improvement
	Math		Other