Project Title:

Amount Requested:

Program Leader / Teacher's Name:

School or Organization Information
School or Organization Name:

Address:

City/State/Zip Code:

Contact Phone Number:

Contact Fax Number:
 

Contact Email address:
 

Number of Children Involved:
 

Tax ID#:

Grade Level/Age Range of Group:

Goals & Objectives:
 

What best describes your program:

Waste Reduction
Water Conservation
Recycling and the 3 R's
The Water Cycle
Pollution Prevention
Litter Prevention
Watershed Education
Soil Erosion
Habitat Restoration/Creation/Beautification
Waste or Water Audits
Waterwise Landscaping
Other

Please provide a detailed breakdown of your project’s budget. (Indicate if you are receiving or applying for additional funds and if so, from whom and how much. List name and contact information of the recycling contractor if applying for recycling program materials.)
 

Project Timeline: (Include start date, event date, end date, and summary submission date.)