Windham Tech PFO

Financial Assistance Application

Windham Tech Organization requesting funding:   ______________________________

Coach or Chairperson   ______________________                 Phone # __________________

Purpose of funding:  ______________________________________________________

                                     _________________________________________________________________

Number of Students Benefiting    _______                   Date funds required  ____________

Estimated Expenses:         

1.______________________________________________               $____________

                                                      (Explanation of expense)

2.______________________________________________               $____________

3.______________________________________________               $____________

4.______________________________________________               $____________

Other Source(s) of Funding?

1.______________________________________________               $____________

2.______________________________________________               $____________

Total Amount Requested:                                $____________

Chairperson or Athletic Director’s  Signature _________________       Date___________

COMPLETE AND RETURN TO WT PFO BY NOVEMBER 1

(Do not write below this line - For PFO use only)

Date of receipt:  _____________           Considerations:  ________________________________________