Name of Teacher, Doctor, Clinician, or Professional nominating the project/child for educational assistance:
(If awarded, you will serve as the primary contact)
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 firstname.lastname@example.org for consideration. Project Acceptance will be made within two weeks after form submission. Questions may be emailed to email@example.com.
Signature of Nominating Person:
If applicable, signature of parent authorizing the nomination of their child for a scholarship: