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Contact Information
Educator
Educator's name: (required)
Educator's school email: (required)
Educator's school confirmation email: (required)
Home email: (required)
Home confirmation email: (required)

Additional applicant names:
(if applicable)

School Information
School Name: (required)
Estimated School Enrollment:
Address - line 1: (required)
Address - line 2:
City/State:
County:
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School Telephone: (xxx-xxx-xxxx) (required)
Secondary Telephone: (xxx-xxx-xxxx)

Principal/Dean
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Director of Curriculum/Department Chair
Name: (required)
Email Address: (required)

How did you find out about the Cornhusker Motor Club Foundation (CMCF): (required)
What is the curriculum
for your program:
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Goal of Program
a. Please explain your program idea.
b. How will this enhance classroom instruction?
c. How will students benefit?
d. Is there a student demand for this activity?

How many students will be impacted by this program? (required)

Project/Program Specifics
a. Who will be involved in this program?
b. How long will the program last?
c. Can the program be reproducted with little or no cost in the future?
d. What adjectives would best describe the program or its effects?

Results and Evaluation
a. What results do you anticipate?
b. How are the outcomes measurable?
c. Are there any foreseeable problems with this plan?
d. How could they be prevented, or how could the plan be changed for the future?

Program Budget

Cost of Project
Itemized Project Cost Amount
(Don't include commas)
$
$
$
$
$

Existing Funding Sources
Additional Funding Source Amount
(Don't include commas)
$
$
$
$
$
Total grant amount requested (May not exceed $2,000)
from the Cornhusker Motor Club Foundation:
$
   (required)

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