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Grant Application Form

HSDM Grant Application

Please complete this online form to apply for the 2017-18 Hawaii Schools Digital Media grant. The application must be completed and submitted online in digital formal – printed applications will not be accepted. 

The 2017/18 application must be received by 2:00 P.M. on Wednesday, August 31, 2017.

The grant evaluation criteria include: clear project description, impact on students and curriculum, innovation; accountability, need, and a complete and thoughtful application.

Contact Phil Bossert with questions at bossert@hawaii.edu or 808-203-9097.


School Name*

Project Name*

School Affiliation*

Principal/Head of School's Name*

Primary Contact First Name*

Primary Contact Last Name*

Mailing Address*

Address 2

City*

State*

Zip*

Island*

Tel (xxx-xxx-xxxx)*

Your Email (required)

Grant Information
Your HSDM video submissions should focus on one or more of the themes below. *
Examples are listed below each theme (or feel free to formulate your own concept as long as it is based on one of the six themes).
Please check to indicate which theme(s) your project will be addressing (you may select more than one).

Describe your HSDM project*

How will this project have an impact on student growth, learning, and their future?*

Based on the above description and recognizing the following video requirements, I am applying for the following award amount (select one)*

How do you anticipate this project will be implemented and/or sustained in your curriculum?*

How will this project be integrated in your curriculum (check all that apply)? *

What is the total student population at your school?*

Direct Student Impact (Estimate total number of students participating actively in the HSDM program)*

How many years old is your school's video program? *

Is the program you have described a new program to your school? *
YesNo

If No, please explain the planned advancement of your existing program*

Did your school receive funding from this program during the last school year? (Note: This does not affect your eligibility) *
YesNo

Will you, or have you in the past, participated in any local video events (check all that apply)?

Describe what you perceive to be your biggest training need to make your video project successful. *

Specify the payee for the Grant funding (i.e. who would we make the check payable to?)*

Grant Application Certification
Certification Statement *
By completing and submitting this information I certify that I have discussed this application with school administration and have the support of my principal/head of school and school. I also agree to provide the programming specified above and to complete a mid- and final-report by the timeframes provided by HSDM. I also understand that all programming that is produced should meet all copyright and technical requirements (refer to Instructions for Submitting HSDS Video Projects at http://www.video.k12.hi.us/hsds-resources) and be submitted to the state K-12 Educational Access provider Video Production & Distribution Group for possible inclusion in the monthly Hawaii Student Digital Showcase on DOE TEACH channel 356 or QAM 46.56.