ClassZoom School Supplies Fund Request

(should be on school letterhead if sent via fax/mail)

Teacher's name and function at school:

Description of need:

Itemized list of items needed, including estimated cost if purchased locally:

Total value requested:

I understand and agree that any funds sent to me by the ClassZoom project of A Grain of Hope Foundation, Inc. will be used solely for the purpose of providing school supplies and related materials to needy students. I also agree that any funds leftover after purchasing the requested items will either be returned by me to the Foundation or kept in a "kitty" to be used for future needs of a similar nature in my classroom or school.