The Cincinnati Section of
                      The American Chemical Society
                                    
                      Educational Grant Application

                                                Date: ___________________

Name:  _______________________________________________________________________________________

Organization:  _________________________________________________________________________________

Address of Organization:  ________________________________________________________________________
_____________________________________________________________________________________________

County:  _________________________  State:  ____________________  Zip Code:  _____________________

Name and Title of Official Certifying Organizational Compliance with the Grant:


Signature:  ____________________________________________________________________________________

Name/Title (print or type)  _______________________________________________________________________

How many individuals will benefit from the grant if your proposal is funded? _____________________________

Are you a Member or an Affiliate of the ACS?  _____________________________________

Grant criteria: Funds are to be used to improve chemical education in the area served by the Cincinnati Section
of the ACS?

Grant proposal: The proposal should be 300-500 words, double-spaced on official letterhead. It should describe
the objective(s) of the project, how the project is to be carried out, how the project would improve chemical
education, how the program fits into the education program (if the applicant is from a school) and who would
benefit. Also, the proposal is to contain a detailed budget which outlines expenditures, the amount being
requested from the Educational Grant and the amount being requested from other sources.

Send 5 copies of this Application and 5 copies of the Proposal to:

Ginger Tannenbaum
Fairfield High School
1111 Nilles Road
Fairfield, OH 45014

Reports: Grant recipients are required to submit a report to the Committee within one year from the time of
notification of the award. The report will include an outline of how the funds were used, what has been
purchased, if anything, with the funds and what benefits have been derived thus far from the use of the funds.