HEARTS
Show us some love
  • Home
  • Donate/Get Involved
  • About HEARTS
    • Board of Directors
    • PortFest
    • Grants & Programs >
      • Grants >
        • 2022-2023 Grant Recipients
        • 2021-2022 Grant Recipients
        • 2020-2021 Grant Recipients
        • 2019-2020 Grant Recipients
        • 2018-2019 Grant Recipients
        • 2018 Spring Grant Recipients
        • 2017 Grant Recipients
        • 2016 Grant Recipients
        • 2015 Grant Recipients
        • 2014 Grant Recipients
      • Senior Sing-A-Long >
        • Senior Sing A Long Lyrics Jan 24
        • Senior Sing-A-Long Feb 21
        • Senior Sing-A-Long April 18 2021
        • Senior Sing-A-Long May 16 2021
        • Senior Sing-A-Long May 16 2021
      • HEARTS Master Class Series
      • 2017 Grants in Action
      • Photos
    • Sponsors
    • HEARTS in the News
    • Recognition
    • Contact >
      • Disclaimer
  • Grant Application 2023-24
  • Gina Farasciano Fund
  • Curtains Up 2022
  • School Authorization form
Picture

 
​SCHOOL AUTHORIZATION FORM
 
*Please submit this form by the grant application deadline date of March 25, 2019.
 
CONTACT INFORMATION
 
Name of Primary Applicant: ______________________________________________________________
 
Email: _______________________________________________________________________________
 
Telephone: ___________________________________________________________________________
 
School/Organization Affiliation (if applicable): _______________________________________________
 
Program Title: _________________________________________________________________________
 
SIGNATURES OF AUTHORIZATION – please obtain signatures where applicable, but everyone needs to have the principal sign if this is a school grant.
 
School Principal(s): _____________________________________________________________________
 
 
Buildings and grounds staff - for anything with electricity etc. use on school grounds:
 
______________________________________________________________________________________
 
 
Teacher or Administrative Partner - (if primary applicant is not a teacher or administrator in the PWSD):
 
_____________________________________________________________________________________
 
 
Staff for technology usage - including any usage of a computer or computer network:
 
_____________________________________________________________________________________
 
 
Applicants can submit this signature form by:

Email: info@heartspw.org
M
ail:
HEARTS,
PO Box 1192 
Port Washington, NY 11050
 
Thank you!