Restricted Donation/Grant Form

Restricted Donation/Grant Form

<p> Grant #______School Year ______</p><p>GRANT FORM A</p><p>(For grants up to $10,000.00 made directly to Northshore Schools) ______PTA/PTSA hereby grants to Northshore School District in the name of ______School. District account #______A monetary grant in the amount of up to ______Dollars ($______), by check no. ______. This grant is for the sole and express purpose of: ______, including sales/use tax and shipping/handling. It is agreed that the grant funds will be spent for the stated purpose on or before ______(date). The PTA/PTSA will be provided a completed copy of this form after payment of vendor invoice. Any remaining funds will be returned to the PTA/PTSA after August 31st. If property is involved, ______(recipient) agrees to maintain the above- described property at ______(location where above-described property resides) for a period of not less than _____ years from the date of purchase. Date:______PTA/PTSA Officer</p><p>______PTA/PTSA Officer</p><p>Date:______Principal or Principal’s Designee</p><p>Completed original retained by the PTA/PTSA, copy given to the school</p><p>FOR SCHOOL OFFICE USE ONLY</p><p>Purchase Order #/Transaction ID: ______Actual Cost: $______Remaining Balance: $______Date: ______Office Manager Signature: ______</p>

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