2006 ase sponsorship Pledge Form




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Please complete sections A through H. The basic sponsorship is $2,700. Additional amounts pledged go to support additional students. Please be sure the amounts in parts A and E total at least $2,700.



A. will provide a total Name of Organization
sponsorship of $ for _______ apprentice(s) in Saturday Academy’s

Amount Number
ASE Program, subject to any necessary approval as noted below.


  1. Funding is: _____Approved _____Pending Date approval expected: ___________




  1. Source of funding__________________________________________




  1. Choose one:




1) _______Payment will be in the form of a contribution to Saturday Academy (gift

acknowledgement will be sent by Saturday Academy).

OR



2) _______Payment requires (check all that apply): ______Invoice ______Mentoring organization’s contract form ______Inter-governmental transfer ______Grant funds transfer ______Other (specify)___________________________
Please begin processing any special documents your company/agency requires as soon as possible.
E. I request that Saturday Academy grant funds provide $__________toward the sponsorship of this student. Please note: Grant funds are limited and are allocated based on the discipline and location of the apprenticeship.**
F. An additional $______________ is pledged to sponsor other students in the program.



Please type or print clearly.
Name of Mentor(s):
G.) Position Sponsor (Name of person(s) responsible for arranging funding, if different from mentor):


Name Organization


Mailing Address (include Mail Stop) City State Zip

( ) Phone

(Please see next page.)

H.) Invoice, or Pledge reminder (for contributions)
should be sent to:


Name Organization


Billing Address (include Mail Stop) City State Zip
( )

Phone P.O. # (if applicable, please attach copy)

I.) Date you would prefer the invoice or pledge reminder ______________. (If no date is indicated, invoices and pledge reminders will be sent in May.)


J.) Fiscal Year of your organization: From ____________________ to ________________________




**Because ASE would like to serve as many students as possible with our limited grant funds, students who are supported by ASE grant funds will not be paid a stipend. Students will be notified of this in the ASE Position Description Book. The exception to this is for students who are on free/reduced cost school lunch; these students will be paid a stipend of $1,000.00 regardless of the position they are chosen for.

Please return this form by February 13, 2006 to Saturday Academy/ASE:
Saturday Academy/ASE, Portland State University, P.O. Box 751, Portland OR 97207

email, ase@pdx.edu



fax 503-725-2335


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