eco tech application captain planet foundation

ECO-TECH GRANT APPLICATION page 1Complete all seven pages of grant application

Please Note: Do not mail and email this document as your application. This document is only for review.

Organization Name:

Tax/EIN Number:

Address:

City, State, Zip:

Country:

International Address:

Grant Request: $2500

Grant recipients are encouraged to find cash and/or in-kind contributions to match or exceed the amount requested from Captain Planet Foundation. (In-kind contributions include donated supplies or services). Please describe your ability to match the proposed grant. Note: "sweat equity" or volunteer labor may be counted as part of a grant recipient's match, but must be valued at $10 an hour.

a. Match Cash Amount: $ (Check one) Pending Confirmed

b. Value of In-Kind Contribution: $ (Check one) Pending Confirmed

c. Sweat Equity/ Volunteer Hours: $ ______ x $10/hr. =____

Total Match Amount: (a+b+c)

Project Title:

Project Summary: (Provide a brief summary of the proposed project, indicating how students will be actively engaged in learning about the environment and how technology will be integrated. This may be the only information the Board of Directors reads about your grant.) (Maximum characters: 1000)

Grant Project Leader Contact Information (Email, work phone and cell phone required) Name of person responsible for carrying out proposed project:

Email:

Work Phone:

Cell Phone:(required)

Current Position:

Number of Years in current position:

Briefly describe prior experience implementing activities related to the project and your role in this project: (Maximum characters: 1500)

Has the organization or Project Leader previously applied for a grant from CPF?

If yes, was the grant awarded?

If grant awarded, provide project title: and year:

Administration Contact Information

Name of organization's CEO:

Position:

Cell Phone:(required)

Email:

Organization's Annual Operating Budget (except schools): $

Organization Description:(Please describe the normal operation or mission of organization) (Maximum characters: 350)

Organization's Role in Proposed ProjectHas the school or organization previously implemented similar projects?

Does the organization have a stated policy or mission that supports or encourages environmental education: yes / no

If yes, please attach a copy of this policy or mission statement, using the section at the bottom of this page.

If no, please attach a letter from the school principal, school district office, or executive of the organization that indicates the authority to implement this project.

Briefly described the organization's prior experience implementing activities related to the proposed project: (Maximum characters: 1500)

ECO-TECH GRANT APPLICATION page2How will technology be integrated in the proposed environmental education project? (Maximum characters: 1500)

What is innovative (new or experimental) about the proposed project (if anything)? (Maximum characters: 1500)

Specify which technology will be . . . a. used by students (if any)?b. used by teachers (if any)? c. researched by students (if any)?(Maximum characters: 1500)

How will the proposed project incorporate... a. engineering challenges (which identify a problem and certain constraints such as limited time, funds or materials), OR b. the iterative design process (where students define a problem, brainstorm solutions, design a solution, make a model, test and analyze how well the model works, redefine the problem and repeat the cycle, until an optimum solution is reached and shared or implemented)(Maximum characters: 1500)

How does technology enhance project outcomes, including student learning and benefits to the environment? (Maximum characters: 1500)

ECO-TECH GRANT APPLICATION page3Partner Information

(include outside organizations that will support implementation of the project programmatically, financially, technically, or through in-kind contributions of

materials or services)Identify at least one outside organization that will support implementation of the

project

Partner Organization #1 (required)Name of Organization:

Contact Person:

Phone:

Email:

Describe the partner's role in implementing the project: (Maximum characters: 1500)

What are the partner's normal operations or activities: (Maximum characters: 1500)

Has the partner been involved in any similar projects:

If yes, briefly describe partner's prior experience implementing similar activities: (Maximum characters: 1500)

Partner Organization #2 (optional)Name of Organization:

Contact Person:

Phone:

Email:





Partner Organization #3 (optional)Name of Organization:

Contact Person:

Phone:

Email:





ECO-TECH GRANT APPLICATION page 4Project Description

(Please describe your project succinctly)

Project Need and Rationale What problems or needs does the project solve and how? How were those needs identified and authenticated? (Maximum characters: 1500)

What will children learn from the proposed project? List one or more educational benefit(s), including any curriculum standards that will be met. (Maximum characters: 1500 for each)

1.2.3.4.

What is the environmental benefit of the proposed project? List one or more. (Maximum characters: 1500 for each)

1.2.3.4. How will children be actively engaged in learning through this project? (Maximum characters: 1500 for each)

1.2.3.4.

What project outcome are anticipated? Quantify expected results, such as "2 raised garden beds built", or "12 lessons created," or *"50% increase in content knowledge as evidenced by pre/post test scores") *At least one example should show assessment of improvement). (Maximum characters: 1500 for each)

1.2.3.4.

ECO-TECH GRANT APPLICATION page 5

Project Planning Process Describe how you included teachers, students and other stakeholders in the planning process for the proposed project. For example, have you conducted a survey to determine need and support for the project? Set up a project Steering Committee? (Maximum characters: 1500)

Implementation Plan List the sequential steps/tasks you will take to implement the proposed project. (Maximum characters: 1500)

Is the proposed project part of a larger program? If so, please tell about the larger program. (Maximum characters: 1500)

Faculty/Staff Involvement identify positions of participating faculty / staff, and their involvement in planning and implementing the project. Position Role

Project Evaluation

Students directly participating in or benefiting from the Proposed ProjectGrade / Age Number of Students Grade / Age Number of Students

Total Number of Students, all ages and grades

Percentage of children who receive free or reduced lunch

Describe, if applicable, the role of students in planning this project: (Maximum characters: 1500)

Potential Project Challenges or Obstacles Show how well you have thought through the project, how realistic you are, and how resilient or resourceful you can be. (Maximum characters: 1500)


Project Sustainability: Identify ways in which this project 1) has lasting value and 2) the methods by which it can be continued after grant funding ends. For example: "use of cedar ensures benches will last 10 years" or "sales of bee balm will generate funds to continue program next year," or "training 3 teachers as facilitators in Project Wild will enable them to certify all new teachers cheaply". (Maximum characters: 1500)

Project's Eco-Friendly Practices List eco-friendly design, practices and purchases. For example: "recycling bins made from repurposed buckets," or "no pesticides will be used in garden," or " 50% recycled content," or "untreated wood to build birdhouse". (Maximum characters: 1500)

Project Deliverables List what will be the project deliverables or products. CPF is always looking for ways to share best practices with other organizations, like lesson plans, project design plans, etc. What will you share with CPF from your project that could help others replicate it? (Maximum characters: 1500)

Project Evaluation: How will the success of this project be defined and measured? How will student improvement be assessed? Please keep in mind that evaluation should be designed to assess the effectiveness of project processes and outcomes with respect to stated educational goals, environmental goals, and technology integration. (Maximum characters: 1500 for each)

Project TimelinePlanning Start date: (mm/dd/yyyy) End date: (mm/dd/yyyy)

Implementation Start date: (mm/dd/yyyy) End date: (mm/dd/yyyy)

Evaluation Start date: (mm/dd/yyyy) End date: (mm/dd/yyyy)

Final Report Due date: (mm/dd/yyyy) (within 30 days from end of the grant period)

Project Budget: List quantities, items, unit costs, grant funds requested for each item, match funds or in-kind designated for each item, and totals. Use a calculator to check math. Group expenses by major project elements or purposes.

Qty. / Item Description / Unite Cost / Grant Amount / Match Amount / Source of Match / Total for Grant and Match Fields

Project Cost-Effectiveness

http://www.metacalc.com/

Total Grant Budget $ / # children served: = $ Cost per person, grant budget

Total Project Budget $ / # children served: = $ Cost per person, total project budget

Budget Narrative: Explain project expenses. Tell how supplies, materials and equipment will be used. Justify expenses in terms of cost effectiveness, longevity, eco-friendliness, educational value, etc. Note any discounts. Describe any special fundraisers or sources of matching funds.


Domestic Grant Applicants please attach:

A signed and dated letter from the school principal, school district office, or executive of the organization that:

specifies that the Project Leader/Director has the authority to implement this CPF-funded project.

grants permission and provides a release for the Captain Planet Foundation to use, publish, or link to any grantee photo, video or website material for CPF’s promotional activities, including project plans, materials developed during the project, and reported results. Such permission indicates that the grantee has sought and received permission from individuals included in photos, as well as parents or guardians of any minor chilren in such photos.

Organizations with 501 (c)(3) status must have included a copy of their Internal Revenue Service "Determination Letter."

International Grant Applicants Only, please attach the following documents:

Organizational Document(s): Please scan and upload one of the following organizational documents: Articles, M0U, Charter, By-Laws, etc. The document should have the stamp of a government agency. If it does not then please upload a recently notarized copy. This document must include a dissolution clause.

Financial Documents: Please submit financial information for the most recently completed fiscal year AND a budget for the current year. All financial information should be detailed and accurate and include a thorough breakdown of program spending and administrative costs. Please be sure to include sources of income.

List of Staff & Board: Please provide the names of senior staff and board members, including phone numbers and email addresses.

Program Materials: Please attach materials that tell us about the programs that you are operating to further your organization's mission. The more detailed these

documents are, the better. We would like to see what you're doing, how you're doing it, who you're helping, and how long you've been running these programs.

Letter of Reference: A letter of reference should come from someone familiar with your work and who has seen first-hand your organization's operations and impact. We recommend that you request references from funders, collaborating organizations, prominent community members, or beneficiaries, among others. Please do not submit letters of reference from a staff, board members, family, or individuals involved in the implementation of programs.

International Program and Budget Notes Explain cultural significance of (and justification for) any project plans or budget requests that do not meet Captain Planet Foundation Guidelines. (Maximum characters: 1500 for each)

International Certifications

Non-DiscriminationI certify that the organization named in this application (applicant) does not discriminate in its recipients of services on the basis of a person's race, political orientation, religion, gender, sexual orientation, age, national origin, ethnicity, ancestry, marital status, veteran status, or mental or physical disability or any other status prohibited by applicable law. Captain Planet Foundation will not support any program which requires exposure, adherence to, or conversion to any religious doctrine in order to be a beneficiary of the program. To clarify, a direct service program run by a faith-based organization may be eligible, provided that the program's beneficiaries are not encouraged or required to learn about, adhere to, or convert to that organization's religious doctrine as a condition of receiving service from the program.

Signature of Organization’s CEO:

International Anti- TerrorismI certify that the organization named in this application (applicant) is in compliance with all statutes, Executive orders, and regulations restricting or prohibiting U.S. persons from engaging in transactions and dealings with countries, entities, or individuals subject to economic sanctions administered by the U.S. Department of the Treasury's Office of Foreign Assets Control. The organization named in this application is aware that a list of countries subject to such sanctions, a list of Specially Designated Nationals and Blocked Persons subject to such sanctions, and overviews and guidelines for each such sanctions program can be found at www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx. Should any change in circumstances pertaining to this certification occur at any time, the organization will notify Captain Planet Foundation immediately.

Signature of Organization’s CEO:


Checklist

Prior to submitting an application confirm that you have provided all required information. If not please upload documents now.

Completed all parts of the application.

Provided a signed and dated letter from the school principal, school district office, or executive of the organization that:

• specifies that the Project Leader/Director has the authority to implement this CPF-funded project.

• grants permission and provides a release for the Captain Planet Foundation to use, publish, or link any grantee photo, video or website material for CPF’s promotional activities, including project plans, materials developed during the project, and reported results. Such permission indicates that the grantee has sought and received permission from individuals included in photos, as well as parents or guardians of any minor children in such photos.

Organizations with 501 (c)(3) status must have included a copy of their Internal Revenue Service “Determination Letter.”

International Organizations have submitted the extra documentation required.

For questions regarding our Small Grants program contact Kathy Lively at 404-522-4159 or email [email protected].

Incomplete applications will not be considered for funding. Due to limited staffing CPF is unable to contact applicants to request missing information.