$100 Grant Application Form Local councils may customize this form. For example, additional information may be requested of the Scout; instructions, background information, council contact Name: Age: information, and approval signature lines may be added. Existing information on the application should remain. Address: City: State: Zip code:
Phone No.: Unit No.: Unit type:(Troop, team, crew, or ship) Email: Council: District: Project Information
Provide copies of the Contact Information page (completely filled in) from your workbook as well as the Approval Signatures page and your Fundraising Application Start date (may be approximate): Location of project (city and state): Type of project: Brief description of the project:
Blackhawk Area Council Contact Information Council Staff Advisor: Mr. Everette Sherrod 2820 McFarland Road Rockford, IL 61107 815-397-0210, ext. 7513 [email protected] Council Follow-Up Volunteer: Dr. Roland Barnes 1517 Charnbrook Drive Johnsburg, IL 60051 815-344-9118 (Home) 815-344-3329 (Home Fax) 815-678-7751 (Office) 815-678-6062 (Office Fax) 815-353-1626 (Cell) mouthdr5@gmail .com
Scout’s Obligations
Read all the information you will receive in your packet with your gift card. Write down your gift card number and keep it in a safe place; you will need the card number when it comes time to submit your brief electronic report. After your Eagle Scout service project proposal has been approved, and when you are ready to begin spending, activate your gift card according to the instructions that came with it. The card must be used for purchases of goods or services that are directly related to your project. An outdoor lighting installation project, for example, might involve the purchase of light fixtures, conduit, and wire, and then fees for a licensed electrician to do the hookup to the power source. Note that the card may be used at a Lowe's location or with any vendor that accepts Discover cards. Purchase of food and tools is not permitted. You are not permitted to use the card for anything that does not directly relate to your project. Obtain a receipt for each expenditure made with the card. Take a few “before” pictures at your project site. Display the Lowe’s poster at your project site while you are working on your project. Do the following as soon as possible after your project has been completed, but no later than April 30, 2014. o Submit your receipts to your Lowe's project Council Follow-Up Volunteer. o Take a few “after” pictures of your project, preferably showing what was purchased with the card. o Submit three to five of your best before-and-after photos to your Lowe's project Council Follow-Up Volunteer. o Make a brief electronic report of your project at: www.scouting.us.qualtrics.com/SE/?SID=SV_eED6H5OS7mgFOU5. o Send a copy of your electronic report to the Council Follow-Up Volunteer. If there is any remaining balance on your card after you have finished spending for your project, submit the card to your Lowe’s project Council Follow-Up Volunteer. It is strongly recommended that all materials required for submission to the Council Follow-Up Volunteer be done so in conjunction with the completion of your workbook at the project’s conclusion.
I, the Eagle Scout candidate, hereby agree to accept all of the responsibilities listed herein as a condition of my participation in the Lowe’s National Eagle Project Impact grant. I will submit all materials asked for to the Lowe’s project Council Follow-Up Volunteer as indicated for Blackhawk Area Council.
Eagle Scout candidate signature: ______
I, the Unit Leader, hereby agree to guide and support the Eagle Scout candidate as he strives to complete all of the responsibilities listed herein as a participant in the Lowe’s National Eagle Scout Impact grant program.
Unit Leader signature: ______