Online Grant Application

CLICK HERE FOR
Printable Parental Consent Form

Deadline for submitting proposals is January 26, 2018. Awards will be announced approximately March 30, 2018.

Online Grant Application

I. Requester of Grant Funds (Your Information)

Are you completing this grant request for yourself? *

Yes (Skip to Section II) No

* Indicates required field

Name of Person Completing Grant Request *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

II. Information on Grant Recipient

Name *

First

Last

Address (We will use this as the shipping address for grant recipients unless otherwise specified in comments section) *

Line 1

Line 2

City

State

Zip Code

Country

Your Relationship to Student / Adult *

Teacher Parent Other: Please specify below

Other *

School or Educational Program *

Current Grade (If applicable) *

Age *

III. General Description of Request

Effective 2017-2018 Grants: We will not longer accept links to items, wishlists, shopping carts. Requests must be typed out in an organized manner (see examples).
We will not accept any orders from Best Buy based on prior experiences.
You also have the option to upload a document with requested item(s) or information that would be helpful to the grant committee. You may also upload order forms.
Make sure prices, product numbers, and addresses are accurate and complete, as this will be used to order and pay for the items requested.
The "Ship To" address on the order form should be the student's home address. Most companies will not ship to PO addresses so make sure you have an alternative address.
If multiple items are being requested, prioritize and number accordingly. When applicable, separate each vendor. Be sure to include quantity, item number, item description, cost of items and total amount requested from each vendor including taxes and shipping. Here is an sample request to follow:

Vendor: MaxiAids
1. 79150 Beep Foam Football $35.95
2. 1*85555 Medium Clear Dots (5 X 2.65) $13.25
3. 8025720 Big Keys Keyboard $169.00
Subtotal: $218.20
Tax: $18.82
Shipping: $13.00
Total: $ 250.02

Vendor: Amazon
1. Edushape Sensory See-Me Ball, 7 Inch Color: Blue $13.29
2. Learning Resources Ruff's House Teaching Tactile Set, 30 Pieces $17.59
Subtotal: $30.88
Tax: $1.14
Shipping: FREE
Total: $32.02

Requested Items (For Required Format See Examples Above) *

TOTAL DOLLAR AMOUNT REQUESTED *

Uploaded File (Use this if you choose to upload an order form) *

Max file size: 20MB

IV. Detailed Description of Request
Describe the recipient's need for what is being requested. How does it address the recipient's educational needs?
How frequently, to what extent, and for how long will the applicant benefit from this?

Comment *

What other sources of funding have been investigated? *

V. Certification of Visual Impairment
To be filled out and signed by applicant's Optometrist, Ophthalmologist, or Teacher of the Blind and Visually Impaired.
Please describe the person’s visual impairment and the extent to which it affects his/her functioning.
Failure to complete this section may jeopardize the student's chances of receiving a grant.

Description of Visual Impairment *

By checking the "I Accept" you are signing this documentation electronically. You agree that your electronic signature is the equivalent of your manual signature and the information provided is true to the best of your knowledge.

Choose Any *

I Accept

Electronic Signature *

VI. Consent for Publication

I give ND School for the Blind Foundation permission to publish my child’s award in the district or school newsletters, in the local newspapers, and/or on the NDSB Foundation Website. I understand that the publication may include personally identifiable information about my child, such as my child’s name, grade level, age, and name of school, and description of award.

Choose One *

Yes No, I do not wish to have this information published

Electronic Signature Agreement.
By typing your full name below, you agree that your electronic signature is the legal equivalent of your manual signature.

Electronic Signature of Parent, Guardian or Individual 18 or older *

Upload Signed Consent Form *

Max file size: 20MB

If you are unable to obtain an electronic signature from a parent or guardian or upload the completed form, please send a signed hard copy, located at the top right of this page to:
Proposal Screening Committee
            North Dakota School for the Blind Foundation
            500 Stanford Road
            Grand Forks, ND 58203

Upon completion of this grant application ask yourself:

Did you use current catalogs and order forms?
Did you fill out catalog order form with correct address and cost of items plus shipping?
Did you complete Section VI. Consent from a parent or guardian?
Did you complete Section V. Full detail description and signed by an eye care professional or by a Teacher of the Blind/Visually Impaired?
Did you remember... WE WILL NO LONGER ACCEPT ITEMS REQUESTED FROM BEST BUY?
Did you remember WE WILL NO LONGER ACCEPT LINKS TO WISH LISTS OR CARTS

If you have any questions or concerns about this application please email me at:
drktork@aol.com

Additional Comments or Questions *

Submit

NORTH DAKOTA SCHOOLFOR THE BLIND FOUNDATION

Online Grant Application

I. Requester of Grant Funds (Your Information)

NORTH DAKOTA SCHOOL
FOR THE BLIND
FOUNDATION