Request/Reimbursement for ISF Expenditures

Each school implementing an ISF Program is eligible to receive monetary assistance up to $100.00 to help with project expenses.  Additional funds may be available on a case-by-case basis.  Complete the form below and mail, fax or e-mail it to Richard Welch, Ph.D. at (678) 547-0084 (phone & fax), e-mail: info@antiprejudice.org.

School Name  ___________________________________________________________

Name of Contact Person  __________________________________________________

Phone  _________________________________________________________________

E-mail  ___________________________________________________

Amount requested  $___________________

Please list proposed or reimbursable expenditures (poster board, film, materials, etc.):

__________________________                                      $ __________

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__________________________                                      $ __________

__________________________                                      $ __________

__________________________                                      $ __________

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                                                                           Total       $ ________________