Special Project Continued Funding Application Form

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Identification

Official Name of the Special Project *

Program Coordinator's name *

First Name

---

Last Name

Program Coordinator's phone # *

Contact Person's name *

First Name

---

Last Name

Contact Person's phone # *

Fax number

Email address *

Mailing address *

City or Town *

Province *

Postal code *

Pending approval, funding cheque is:

Payable to

Mailed to

City or Town *

Province *

Postal code *

Special Project Budget

Expenditures

Clinician Costs

Refer to suggested guidelines

Professional *

Student *

Total Clinician Fees

Travel

Mileage ($0.42/km)

Accommodation

Taxi

Parking

Other

Total Travel Expenses

Breakfast

Lunch

Supper

Other

Total Meal Expenses

Administrative Expenses

Promotional/Printing

Supplies

Transportation Costs

Other

Total Administrative Expenses

Special Project Budget

Income

Registration

Refer to suggested guidelines

Student *

Adult *

Other *

Total Registration and Fees

Travel

Mileage ($0.42/km)

Accommodation

Taxi

Parking

Other

Total Travel Expenses

Breakfast

Lunch

Supper

Other

Total Meal Expenses

Administrative Expenses

Parent Association

School Division

Other

Total Grants

Administrative Expenses

Facilities

Clinician

Supplies

Other

Total Donations

Other income

Self-Generated Income

Requested Income

Total Income

Certification

I hereby affirm that I am a member of SMEA in good standing. All eligibility requirements for Special Project Status have ben met and this application, inclusive of all sections above, constitutes a correct and true statement. I further certify that the attached signed financial statement for the current fiscal year is a correct and true statement.

Signature of applicant *

Position

If you require assistance or additional information, please contact the Saskatchewan Music Educators Association office at (306) 256-7187. Applications can be scanned and emailed to smea@sasktel.net or mailed to:

The Saskatchewan Music Educators Association
Box 632
Cudworth, SK.
S0K 1B0

The information requested is information that SMEA is required to submit to Saskatchewan Lotteries Trust.

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