Request Form ITALIDEA-MIDWEST, LTD


				2. REQUEST FORM
				School District (Name, Address & Contact Information) __________________________________________________________________________
				Please provide the following information for each school you would like to include in the program:
				School #1
				· Name, Address & Contact Information
				__________________________________________________________________________
				· Number of classes and grades (ex. 3 classes/ 3rd grade)
				__________________________________________________________________________
				· Total number of students ____________________________________________________
				· Amount of time available for Italian language course (per week) ____________________
				· Start date requested (March for 1 quarter OR August for 1 school year)
				__________________________________________________________________________

				School #2
				· Name, Address & Contact Information
				__________________________________________________________________________
				· Number of classes and grades (ex. 3 classes/ 3rd grade)
				__________________________________________________________________________
				· Total number of students ____________________________________________________
				· Amount of time available for Italian language course per week _____________________
				· Start date requested (March for 1 quarter OR August for 1 school year)
				__________________________________________________________________________
				Teachers
				· Would this position require a full-time or part-time teacher? _______________________
				· Is there an Italian teacher already on-site? Yes _____ No _____
				· If not, do you have a candidate for this position? Yes _____ No _____
				If yes, please attach their resume to this form.

				Draft Budget Requirements
				· Amount requested for TEACHER’S SALARY $_________________________________
				· Amount requested for INSTRUCTIONAL MATERIALS $ _______________________
				TOTAL AMOUNT REQUESTED $ ____________________
				(between $5,000 and $25,000)

				Summary
				**Please attach a summary answering the following:
				1. Why does your school/school district want to participate in the Italian Language program?

				2. Would the school district be willing to assist in funding your school’s Italian program after the first year?

				3. If the Italian Language Program proves to be successful in your school district, would you consider expanding the program within the district?

				____________________________________
				Signature of School District Superintendent

Applications for Schools

Agreement Form

Request Form

Italidea Midwest LTD is a 501 (c) (3) not for profit organization