Provide requested information for each section below. Submit all support materials by email to: or by mail to:
FASE, INC.
475 Valley Street Scottsville, VA 24590
1. Provide your current job description or student status and a statement of your educational philosophy.
2. Provide a brief summary of your professional development plan with specifics regarding how this study will benefit your teaching and learning.
3. Provide the TOTAL cost of professional development activity (itemize all that apply such as travel and boarding expenses) $_______________
Total requested grant funds $_______________
*You may submit additional materials that will help us evaluate your application
1. Provide the length of the desired workshop (hours or days) and suggested dates if possible.
2. How many people (teachers and/or students) will participate?
3. Provide a description of your current orchestra program including the number of students served and any specific goals or outcomes you hope to achieve with the Bornoff workshop. Feel free to include information about your curriculum, particular successes, and/or challenges of the program.
Authorized Signature: The signature below is that of the person authorized to testify as to the accuracy of this application.
______________________________________________________ Date _____________________
(Print Name)
______________________________________________________ Title
1. If no website is available, please describe the program in detail.
2. Provide a short description of the program needs for which funds are requested (answer all questions below that apply).
*Capital Expenditures (A capital expenditure is defined as an item (or group of items) with a life expectancy of more than three years. Examples include equipment such as instruments, cases, music, and music stands, etc.)
1. Itemized list of items to be purchased.
2. Why is this purchase necessary?
3. What long term benefit will the item(s) provide?
4. Who will have access to the item(s)?
Total itemized amount of requested Capital Expenditure funds $_______________
*Operating Expenses (Considered operating costs include classroom consumables and faculty stipends.)
1. Provide an itemized list of items to be purchased or costs covered by the grant.
2. How many students will have access to the items or instruction provided?
Total itemized amount of requested Operating Expenses funds $_______________
1. Describe the program for which funds are requested (i.e., Title 1 school, number of students served) 2. Provide an itemized list of items requested (see FASE website for titles and descriptions).
1. Provide the length of the desired workshop (hours or days) and suggested dates if possible.
2. How many people (students and teachers) will participate?
3. Provide a description of your current orchestra program including the number of students served and any specific goals or outcomes you hope to achieve with the Bornoff workshop. Feel free to include information about your curriculum, particular successes, and/or challenges of the program.
Authorized Signature: The signature below is that of the person authorized to testify as to the accuracy of this application.
______________________________________________________ Date _____________________
(Print Name)
______________________________________________________ Title
