First Name

Last Name

Email Address

Phone

Home Address

Home City

Home State
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Home Zip Code

School/Company

School System

Title

Work Address

Work City

Work State
== choose one == Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

Work Zip Code

Work Phone

How many years have you been teaching physical education?

How long have you been a member of NCAAHPERD-SM and PEA?

Purpose of project: (Clearly describe the purpose of the project.)

Project objectives: (Define specific objectives of the project in terms of measurable outcomes.)

Strategies: (Describe specific activities. services and steps planned to accomplish the objectives. State the project time line.)

Evaluation: (State how and when the success of the project will be determined.)

Funding Request and Budget (Identify amount of funding requested and provide a description of how the money will be spent.)

List specific ways the project will benefit the Alliance membership and/or profession.