Program Partner Confirmation Form

Comments

This field is for validation purposes and should be left unchanged.

Funding will be disbursed once the Program Partner has confirmed the date with the school. Please use this form to communicate that information to Arts, etc

Program Partner(Required)

Contact(Required)

Email(Required)

Phone

School Contact(s) Name, Title and Email(Required)

Brief Description of the Program(Required)

25–30 words briefly describing the program for which you are requesting payment.

Are there any changes to the program description that was submitted in your application? If so, please provide:

Notes about any program modifications.

Program Partner Name(Required)

Date(Required)

Program Partner Signature(Required)

Funding Disbursement

Make check payable to:

Mailing Address for Check:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Amount of Requested Funding: