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:
__________________________________________________
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