Applicant Profile:

First Name *

Last Name *

Email Address *

Phone

Are you a Mountain America Member? *

* Applicants must be a Mountain America Credit Union member to qualify, and membership will be verified before the grant is awarded. Click here to learn more about becoming a Mountain America member.

Name of School

Title/Role at School

School Address

School City

School State

School Phone

Grant Overview:

Grant request amount (must range between $0-$2,000)

For what classroom or learning-based project are you requesting the grant?

What specific supplies will the grant fund?

Are these supplies reusable?

Yes No

Community Impact:

Mountain America is committed to giving back and creating a positive impact in our community.

What impact will this grant have on the students and the local community?

3000 character limit

How many students will be impacted as a result of this grant?

How long will this grant have an impact on the students and community?

Financial Wellness:

Will this grant help improve the financial wellness of your students and the community?

Yes No

By entering my electronic signature below, I confirm that I meet all of the eligibility requirements (listed above) and all of the information contained in this application is true and complete to the best of my knowledge. If asked by an authorized official, I agree to provide proof of the information I have provided on this form. I also realize if I do not provide proof when requested, I may forfeit my eligibility for this grant.

Applicant's electronic signature

Date of Signature