UPPER GRAND LEARNING FOUNDATION

500 Victoria Road North, Guelph, Ontario N1E 6K2

REQUEST FOR GENERAL / COMMUNITY FUNDS APPLICATION FORM

School / Community Group Name _______________________________________________________________________

Purpose of funding ____________________________________________________________________________________

____________________________________________________________________________________________________

Total cost $ _______________________ Amount requested $ __________________________

Sources of other funds ________________________________________________________________________________

Describe the learning objectives of the above _____________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

I, _________________________________________have reviewed this application and

approve the proposed use of funds.

Signature of Principal / Community Group Leader__________________________________________

Date_____________Make cheque payable to _____________________________________________

******Please attach any receipts, invoices or purchase orders******

Complete and return to:

UPPER GRAND LEARNING FOUNDATION

500 Victoria Road North, Guelph, Ontario N1E 6K2

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For UGLF use only

Reviewed by UGLF: ____________________________________ Date___________________

initial

Date paid ________________________________Cheque Number _______________________