Name of Teacher, Doctor, Clinician, or Professional nominating the project/child for educational assistance:

 ____________________________

(If awarded, you will serve as the primary contact)

Contact Email: 

____________________________

Contact Telephone number: 

____________________________

Are you willing to provide a brief written progress report and pictures regarding the outcome(s) of services rendered with CACEASF support? 

_________________________________________________________________________

_________________________________________________________________________

Project/Child’s Name:  ____________________________________________

If applicable, Guardian’s Name:  _________________________________________

Project/Child’s School:  ____________________________________________

Project/Child’s zip code:

_____________________________________________________________

In 500 words or less, please describe the project’s/family’s need for financial assistance to provide educational services or products to meet the needs of the children/child. Please explain how the funds will be used to benefit the children/child and the outcome(s) expected. 

Please email to aknott@caceasf.org for consideration. Project Acceptance will be made within two weeks after form submission. Questions may be emailed to aknott@caceasf.org.

 

Signature of Nominating Person:

 

__________________________________________________

If applicable, signature of parent authorizing the nomination of their child for a scholarship:

 

__________________________________________________