Application for Grant Funds

Date:
Project Date:
Name of Proposed Project:
Name of Applicant(s):
Role of applicant (must be qualified VI personnel): Teacher of VI or Deafblind Childen
Orientation and Mobility Instructor
VI or DB Personnel at a Texas Education Service Center (ESC)
Rehabilitation Counselor with VI or DB expertise
Other
If other, please specify:
Work Contact Information:
- Street:
- City:
- State:
- Zip:
- Work Phone:
- Work Email:
Home Contact Information:
- Street:
- City:
- State:
- Zip:
- Home Phone:
- Home Email:

District or Organizational Affiliation(s) of Applicant(s):
Local School District(s) of Student(s) to be served by this Project:
Project Category (please select all that apply): Social and recreational activities
Fine arts activities
Summer Enrichment
Youth camp or outdoor learning activities
Parent education and support
Assistive technology or low vision devices
Tutoring and mentoring
Project Description:
Project Timeline (date and duration):
- Project Location:
- Please list the home counties of the children served in this project:
Number of Children to be Served:
Age of Child/Children to be Served:
What are the expected outcomes, and how will this project benefit the blind, visually impaired, or deafblind child/children who participate?
- Will you be using volunteers in your project? Yes No
- If so, how many volunteers will be working with you and in what capacity?

Project Budget
Income - Please list all sources of income for the project, actual and prospect, with amounts.
- Source:
- Amount:
- Source:
- Amount:
- Source:
- Amount:
Expenses by category — Please describe expenses (for the proposed project only) and list estimated dollar amounts for each category. If you do not anticipate expenses in a given category, please enter "0" as the amount for that category.
- Alternative format production (braille, audio)
- Amount:
- Description:
- Equipment & Supplies
- Amount:
- Description:
- Food and Refreshments for Participants
- Amount:
- Description:
- Sign Language Interpreters
- Amount:
- Description:
- Fees (event admission, tickets, etc.)
- Amount:
- Description:
- Telephone and Fax
- Amount:
- Description:
- Travel
- Amount:
- Description:
- Other
- Amount:
- Description:
Do you have insurance to cover this event? Yes No
Total amount requested from ABCTX to Conduct the Proposed Project:
Additional comments about your proposed expenses for this project, if any:

Download the permission page for each student and request the parent/guardian sign so that ABCTX can post photos, videos, or audio recordings on our website.
- Please give an address for the check to be sent to:
- Name check should be made out to (must be a VI professional):
Please ask the parent/guardian of your student(s) to sign a permission form so a photo, video, or audio of this activity can be posted on the website. The form can be downloaded from the webpage. ABCTX will use no last names. THEN, please take photos, videos, or recordings of your students and send or email them with your report.

If you have questions or comments, please contact Gloria Bennett at gloria@abctx.org or (512) 206 - 9234.

©2012 All Blind Children of Texas
1100 West 45th Street, Austin, TX 78756

Phone: (512) 206-9234 | Email: info@abctx.org

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