Building Tomorrow's Leaders (BTL) Jr. Program Application

Building Tomorrow's Leaders (BTL) Jr. Program Application
Name of School District*
Name of Participating School*
Address*

Street Address

CityState / Province

Postal / Zip Code
Name of Principal*
Principal Email Address*
example@example.com
Name of Facilitating Teacher *
Facilitating Teacher Email Address*
example@example.com
Facilitating Teacher Phone Number
Please enter a valid phone number.
Estimated Start Date

MonthDayYear
Date
Estimated End Date

MonthDayYear
Date
Who will be participating in the BTL Jr. program? Include grade levels and group/class descriptions; do not name students.
How will the BTL Jr. program be implemented at your school? Explain when, where, and how often the program facilitation will occur.
What is your student-centered goal for the BTL Jr. program?
Fund Request: Estimated number of students X $15 per student.
If you would like to request additional funds, please enter your anticipated expenses and the total amount of the request.
Your signature below indicates your assurances to do the following:
- Submit the teacher program completion evaluation form
- Administer and ensure submission of the student completion survey
- Submit claim for reimbursement in the North Dakota WebGrants system
School Administrator's Signature*

Clear
FOR NDDPI USE ONLY: Approved Amount
Should be Empty: