GNSI Education Fund Application Form
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Please type or print clearly. Use one application for each project and include the required enclosures. Deadlines for application submission are either April 1 or October 1.
- Applicant
Name _____________________________________________________________________
Address/Contact Information
___________________________________________________________________________
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- I am applying:
[ ] as an Individual GNSI Member or [ ] as a GNSI Member representing a GNSI Chapter
If GNSI Chapter, GNSI Chapter Name:___________________________________________
No. of GNSI, Inc. Members in Good Standing _________
- Project (Program, Activity, Resource)
Title_______________________________________________________________________
Date and Time (If Applicable) __________________________________________________
Location ___________________________________________________________________
Description _________________________________________________________________
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- Financial Beneficiary
Role in Project (e.g. Instructor, Developer, Consultant, or other. If “other,” provide specific role.)
___________________________________________________________________________
Name(s), Address(s), and Contact Information
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Attach a current résumé(s) or short biography(ies).
- Budget
- Income
- Registration and/or Other Fees Per Person (If applicable) ________
or: GNSI Member______ Non-GNSI Member______
No. of Expected Attendees_________
Total Expected Registration Income ________
- Other Income (Please itemize.)
a:____________________________________________________ ________
b:____________________________________________________ ________
c:____________________________________________________ ________
- Additional Sources of Funding
a:____________________________________________________ ________
b:____________________________________________________ ________
c:____________________________________________________ ________
- Expenses
Income (Indicate with [x] those for which you would like to apply for funding. Itemize on attached sheet if necessary.)
- [ ] Fee(s) for Instructor, Developer, Consultant, other ________
- [ ] Transportation for Instructor, Developer, Consultant, other ________
- [ ] Accommodation/Lodging for Instructor, Developer, Consultant, other ________
- [ ] Event Room or Space Rental Fee ________
- [ ] Audiovisual Equipment Rental Fee(s)
a:_________________________________________________ ________
b:_________________________________________________ ________
c:_________________________________________________ ________
- [ ] Supplies* ________
- [ ] Advertising ________
- [ ] Printing/Photocopying ________
- [ ] Mailing/Distribution Costs ________
- Other (Please itemize)
[ ] a:__________________________________________________ ________
[ ] b:__________________________________________________ ________
[ ] c:__________________________________________________ ________
(*See Guidelines for concerning provisions to protect attendees from potentially hazardous materials and situations.)
- Total Education Fund Money Requested ________
[ ] I would like to receive partial funding in advance (percentage of total approved funding).
(See Guidelines for details.)
Note: It is requested that the applicant consider implementing a registration fee to help recover expenses. Also, the applicant is strongly encouraged to explore other natural avenues of funding. One of the missions of the Education Fund is to promote the occurrence of GNSI events could not take place without outside assistance. Thus, if additional sources of funding are identified, it helps to conserve Education Fund money for those applicants who are in more financial need. Note: past awards have ranged from $200-1500.
- Advertisement
[ ] GNSI, Inc. Newsletter (required)
[ ] GNSI Chapter Newsletter
[ ] Other
___________________________________________________________________________
Note: All funded projects must be open and advertised to the general public. Use “Other” to describe how you intend to comply with this requirement.
- Standards and Qualifications Form (GNSI Chapter Form, if representing Chapter, or Individual GNSI Member Form, if applying as individual.)
[ ] Attached
______________________________________________________________________________
I certify that the information provided in this application is accurate to the best of my knowledge.
Applicant Signature ________________________________________________ Date__________
If associated with GNSI Chapter, please provide:
GNSI Chapter President
Name____________________________ Signature____________________ Date__________
GNSI Chapter Treasurer
Name_________________________________________________________________________
Address/Contact Information
______________________________________________________________________________
______________________________________________________________________________
Send completed application to the GNSI Education Fund Director (check with GNSI for current contact information).
Revision 08.16.07 |