Norm Pippin mental health fund

In honor of deceased WBLAS principal, Norm Pippin and his wife Norma, the Norm Pippin Mental Health Fund was created. To request funds (staff only), please fill out the request form here below. The purpose of the Pippin Fund is to provide a permanent endowment which will be used to support District 624 social workers, psychologists, nurses, and principals to assist students who have financial needs that prevent them from fully participating in the educational process due to their mental health needs.

Each year (September through July), $1,200 will be awarded ($200 maximum per student). Applications for funds will be accepted until the funds have been depleted for the academic year.

NORM PIPPIN Mental Health Fund - REQUEST FORM

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

Today's Date

MM

DD

YYYY

Name of District Staff submitting the request

First Name

Last Name

Building

Email

Phone Number

(###)

###

####

Student's Initials

Amount Requested

($200 Maximum)

$

Date funds needed by

MM

DD

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:

(Vendor Name)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Signature

*Required Field