Please enter your name.

First: MI: Last:

Please let us know how we may contact you.

Street address:

City: State: Zip/Postal Code:

Telephone number:

E-Mail Address:

Please provide us with the following information about your project.

Describe your project in detail, including how you plan to use technology, e.g., computer software and hardware, as an integral part of the project.

List any and all software applications by title and developer (e.g. "Math Advantage 2002 by Encore Software) that you plan to use. Tell us about any specific software that you would like us to fund. Specifically, how will the requested software applications be used? Include a description of planned classroom/administrative activities you intend to complete using the requested software.

Are you requesting any related hardware for the software application(s) listed above? If so,
please specify the type of hardware and how it will be used (e.g. "A digital camera to capture
images and import into Kid Pix Deluxe 3 application")

Do you know how to use the requested software or do you require software application training?
The DBC Educational Foundation will make every effort to provide Grant recipients
with adequate training and familiarity of the software requested.

What is the total cost of your requested software and related hardware? Also, what if any other project fees would you like us to fund? Please break out costs by line-item for each software application and/or hardware requested.
This will represent the total funds requested from the DBC Educational Foundation:

Number of students in your class?

Will all the students in your class have access to the software? If not, how many will?

With what grade level will you be working?

Please tell us how you intend to evaluate the successful use of the funds granted:

What results do you hope to acheive by the end of the school year?

Describe the method by which effectiveness will be measured?

Please help us understand your technical knowledge:

Have you ever taken a computer class or received any technical training? If so, please describe:

What software applications have you used regularly within the last 12 months?

List any websites you have accessed within the last 12 months for educational purposes:

Who will be responsible for maintaining the computer(s) for your proposed project?
Why do you feel this person is qualified to provide technical support?

Please help us understand your teaching environment

Do your students currently have access to computers in your classroom? If so, how many?

Do your students typically have access to computers at home? If so, how many?

While at school, where do you typically use computers to conduct administrative tasks? In your classroom?
In the library? Other?

Do you use your home computer for school related work? If so, what kinds of things do you do on
your home computer?

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