EDUWellness Grants – For Members By Members – Individual Application Form

Name

Project Name

Email Address

Professional #

School Address

School

Educational Entity

Assignment in the School/System

School Phone

Home Phone

Time Frame of Project

Start Date

Completion Date

Project Description
This description is used to assist in the review process and to outline successful projects on the NSTU website. Please provide a detailed outline of your project including details, the implementation plan, the value of the project to the well-being of plan members and how you will know if the project is successful.

Amount of Funding Requested (recommended limit up to $1,500.00)

Expenses

Services / Consumables / Equipment / Other

The EDUWellness Grant may approve Services such as workshop expenses, rentals and labour fees, consumables such as, paint, paper, certificates, etc., equipment / capital items or other, when they are required to support implementation of the project. (Please itemize in detail below.) Note: consumables must represent a small portion of the budget request.

Description(s)

Cost(s)

Total Expenditure

If full amount is unavailable, will the project be abandoned or modified?

If modified, explain how

Person to be responsible for disbursement of funds/receipts

Person(s) with signing authority

Other Sources of Income

List any other sources of income.

Total Other Income

*Please note, all out of pocket expenses related to the application and subsequent project, will be incurred by the member. Expenses will only be reimbursed upon completion of the project based on the noted completion date and should include a formal summary report with all disbursements and receipts. All projects must be completed prior to the end of the 2022 / 2023 school year. Please acknowledge that you have completed the above application understand all rules / requirements as it pertains to the EDUWellness Grant by clicking the box.