WVHEA  

 

West Virginia Home Educators Association

P.O. Box 4241

Clarksburg, WV 26302

Phone 1-800-736-WVHE (9843)

 

Regional Outreach and Development Grant Application

 

Name of WVHEA Member_______________________________________ 

 

Address_______________________________________________________

(Street or P.O. Box)

_____________________________________________________________

(City/State/Zip)                                                                                                                        (County)

 

Phone_________________________E-mail__________________________

 

Date and time of event___________________________________________

 

Location/address of event ________________________________________

 

_____________________________________________________________

 

Briefly describe event/project and amount requested, $500 maximum per request.  (May attach additional sheets as necessary.)

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

Please explain how this project or event is consistent with WVHEA purposes as stated in the Constitution and By-laws.____________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

_____________________________________________________________

 

Contact person (if other than applicant)______________________________

 

Address (if other than applicant)___________________________________

(Street or P.O. Box)

 

_____________________________________________________________

(City/State/Zip)                                                                                                                        (County)

 

Phone_________________________E-mail__________________________

 

If children are involved please describe supervision provided____________

 

_____________________________________________________________

 

_____________________________________________________________

 

Anticipated cost to WVHEA members____________ others_____________

 

Please attach a detailed budget for entire project, with an estimate of fixed and variable expenses and income along with any anticipated fees to be charged for participation and discounts for WVHEA members.

 

Mail completed application to: WVHEA, P.O. Box 4241 Clarksburg, WV 26302 

Questions?  Please call 1-800-736-9843 or email newinfo@wvhea.org.

 

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For Office Use

Date application received:____________________     Scheduled for review: _______________________

 

Received by:___________________________________________________________________________

 

Rev. 02/13