2018-2019 Parent Leadership Training/Parent Trust Fund Grant
Intent to Submit Proposal

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* 1. Name of Organization:

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* 2. Organization Contact Information:

Name of Contact Person

Title

Address

City

State

Zip Code

Email Address

Phone Number

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* 3. Fiduciary Contact Information (If applicable):
* Please note: A fiduciary is an external entity who is acting on your behalf in legal and/
or financial matters. The fiduciary is not an organization's internal finance director or
accounting representative.

Name of Fiduciary

Fiduciary Contact Person

Email Address

Phone Number

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* 4. Which parent leadership training model(s) and number of cycles in each model will be offered in 2018-2019. If the parent leadership training model is not listed, please add it to the other category (please keep in mind, it must be evidence based and the maximum amount will be determined by the curriculum). In addition, please note: Applicants will be allowed to apply for a maximum of two training models/cycles, for a maximum total dollar amount of $36,492.00. (Applicants will only be awarded funding for both curriculum models as funding is available).

	Number of cycles
PLTI	PLTI Number of cycles menu
PLTI/CLTI	PLTI/CLTI Number of cycles menu
PEP	PEP Number of cycles menu
PSEE	PSEE Number of cycles menu
VFF	VFF Number of cycles menu
ASPIRA/APEX	ASPIRA/APEX Number of cycles menu

Other-please specify training model(s) and number of cycles proposed.

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* 5. Anticipated funding request for 2018-2019 (For planning purposed only. The amount in final proposal can be different, though please keep in mind, applicants will only be allowed to apply for a maximum total dollar amount of $36,492.00).

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* 6. If applicable, please list the amount of parent trust funds received since 2013 to conduct parent leadership training, the models and number of cycles and the amount of parent trust funds returned and explanation of why the funds were returned (if any).

For example:
In 2014-2015 we received $7,177.00 for 1 cycle of PEP, no funds were returned.
In 2016-2017 we received $18,443.00 for 1 cycle PSEE, returned $552.00. Funds were returned due to donations for food.