ANGEL FUND - REQUEST FORM

This form is to be used only by District 624 Principals, Psychologists, Social Workers, or School Counselors.

Today's Date

YYYY

Name of District Staff submitting the request

First Name

Last Name

Building

Phone Number

(###)

###

####

Student's Initials

Amount Requested

Date funds needed by

YYYY

Explanation of what funds are for.

Is there a plan for sustainability?

State what other resources have been explored (School District, State, Government), and the status for each.

Make check payable to:

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Signature

*Required Field