Amount Number ASE Program, subject to any necessary approval as noted below.
Funding is: _____Approved _____Pending Date approval expected: ___________
Source of funding__________________________________________
1) _______Payment will be in the form of a contribution to Saturday Academy (gift
acknowledgement will be sent by Saturday Academy).
2) _______Payment requires (check all that apply): ______Invoice ______Mentoring organization’s contract form ______Inter-governmental transfer ______Grant funds transfer ______Other (specify)___________________________ Please begin processingany 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):
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