The mini-grant can be used to purchase pencils, stress balls and most importantly,
food! We have heard many times, “If you feed them, they will come!”
Please fill out completely and mail or fax to the address below.
Name: ___________________________________________________
School: __________________________________________________
Street Address: ___________________________________________
City: ___________________________ State: _______ Zip: _________
County: ___________________________ Phone: ________________
Expected Date of Session 1: _________________________________
Expected Number of participants: ____________________________
How many student journals do you need? ______________________
Email Address: ____________________________________________
Social Security Number: ____________________________________
Signature: ________________________________________________
We have a new requirement for fiscal year 2005. We are required to have W9 forms on anyone we pay any money to. Effective July 1, 2005. This is the link where you can down load the form please fill it out and fax it to me with the stipend request www.irs.gov/pub/irs-pdf/fw9.pdf If we don't have this form on file, I won't be able to process your check. Please remember to save your receipts and turn them in when you request your stipend. Please fax this form and the W9 form to (304) 342-6096