Online Grant Application - Air Quality/Energy Grant

Air Quality / Energy Grant

Please supply the information below to start the air quality/energy grant application.

If you have any questions concerning this application please contact Shari Wilson

Date of Application: *

Name of School: *

Name of School District and USD #: *

Name and District Number

Contact Address

Contact Person and Title: *

Individual responsible for day-to-day project management. Please provide a title for this individual.

Address: *

City: *

State: *

Zip: *

County:

State of Kansas House of Representatives District Number: *

Mailing address for payments:

If same as the 'Contact Address' above, please leave this field blank

Telephone Number: *

Fax Number:

Email Address: *

Web page, if applicable:

FEIN (IRS) tax number:

Please tell us how many students are enrolled in the school: *

1. Describe your project: *

2. Describe the environmental benefits of your project.: *

3. Describe how you will use environmental education to tie the project to classroom curriculum in your school.: *

Include your learning objectives, how your students will be involved, and approximately how many parents, students, and community members will be impacted.

4. Provide any additional information about your project:

5. Please provide a timeline for your project:

6. Provide a basic budget for your project:

Include the following information: itemized list of expenses, sources of funding beyond a Kansas Green Schools Grant, and which expenses you are requesting a Kansas Green Schools Grant to cover. If matching funds are required, specify how you will meet this requirement. In-kind donations such as community donations, volunteer time, services such as printing provided by the school, etc. are acceptable sources of matching funds. For a sample budget, click here.

Total Budget

Please provide grant amount requested and related match for each
of the following categories.

State Grant Funds

Match Amount

Total Cost

Salaries

salaries_sfg: $

salaries_ma: $

Salaries - Total:

travel_sfg: $

Travel

travel_ma: $

Travel - Total:

Supplies

supplies_sfg: $

supplies_ma: $

Supplies - Total:

Capital Equipment

ce_sfg: $

ce_ma: $

Capital Equipment Total:

Prof. Services

Prof. Services State Funds Grants: $

Prof. Services Match Amount: $

Prof. Services Total:

Other

Other - State Funds Grants: $

Other - Match Amount: $

Other - Total:

Total

Total - State Funds Grants:

Total - Match Amount:

Total - All Categories:

Budget Category Definitions and Explanations

Salaries:: Grant funds should not be used to pay salaries; however, salaries may be used as match.
Travel:: Includes costs incurred conducting public education, seminars, training, etc.
Supplies:: Include public education materials/supplies and items and equipment with a cost of less than $500.
Capital Equipment:: Is for purchase of equipment with a useful life of at least one year and a cost of $2,500 or
greater
Professional Services:: Include consultants and contractors fees
Other: Includes expenditures for items that don’t fall into the above categories or cash match

Certification

The person signing this document must have the authority to contractually bind the applicant or be the designated fiscal agent. For schools, this is generally the principal, superintendent, or board president. Please be sure to secure all necessary approvals from government bodies prior to signing this application.

The undersigned is an official authorized to represent the applicant.

I certify that all proposed activities will be carried out; and all grant money received will be
utilized solely for the purposes for which it is intended; that records documenting the
planning process and implementation will be maintained and submitted when requested. KACEE and KDHE are hereby granted access to inspect project sites and/or records.

Signature of Authorized Representative: *

Please type the name of the Authorized Representative, this will suffice for a signature

Date:

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