• ASSIST Grant Application Form

    ASSIST Grant Application Form

  • Year of Application

    Typical Academic year runs from Mid August - Mid May, but you may go beyond if your school plans to run the program over the summer.
  •  - -Pick a Date
  •  - -Pick a Date

  • Academy Information

  • ASISST PROGRAM ROLE DESIGNATION

  • Every ASSIST-funded school must have a Primary Grant Administrator. Schools are highly encouraged to also identify a Program Coordinator. The Program Coordinator could fulfill some of the roles described below, such as Student Supervision, Program Evaluation, and Senior Mentor Liaison. However, this individual should not be responsible for a majority of the roles.  To review each individual role and its funtion, click the link under Review Role Descriptions.

    Refer to the Program Guidelines for having a Program Coordinator

  • Click To Review Role Descriptions




    • Do you have other roles to add? 

  • Review of Role Descriptions




  • GRANT FUNDING REQUESTED

    Please provide the following information about your program budget for student wages (do not include any figures for program assistant funding ).

  • Program Administration

  • Student Engagement Activities

    Please provide a basic job description for the students who will be participating in your ASSIST program.
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  • Service Setting / Matching Participants

  • On the provided spaces below, enter the estimated number (in digits) of students that are projected to work at each setting.



  • Program Preparation and Safety Measures

  • Program Awareness

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  • Program Financial Administration

    In this section, you will be asked to provide how you plan to manage the finance aspects of the ASSIST program.
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  • Instructions to sign this form. Hold your mouse over the field provided and draw your signature as you would with a pen on paper.

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