Scientific Learning assists customers looking for grants by providing the

following assistance:

Review final versions of grant applications upon request
(1-2 week advanced notice).

(Please note: Scientific Learning does not write grant proposals for customers,

but instead supplies the above assistance.)

By filling out the following form, you will assist us in determining what is the

best grant information to send you.

Fields with an * are required.

Contact Info

First Name:

Last Name:

Job Title:

School / Organization:

Type of Organization:

Address Line 1:

Address Line 2:

City:

State:

Zip / Postal Code:

Phone with Area Code:

Ext.

Email:

Web Site:

School Information

Type of Project:

If Other, please specify

Demographics of School

Number of Students

	Yes	No
Do you already have Fast ForWord products or Scientific Learning Reading Assistant software in your school/organization?

	Yes	No
Does the school/organization have adequate technology to support a Fast ForWord or Reading Assistant project?

I need assistance with (check all that apply)

Choosing an appropriate funding source (3-6 month process)

Writing and submitting a grant proposal (1-3 month process)

Reviewing and editing a grant proposal (1-2 month process)

Researching and gathering information to be included in a grant proposal (2-4 week process)

If other, explain:

Grant Details

What Grant opportunity have you identified for your project?

Due Date for the Grant Application:

Name of the grant writer/person responsible for preparation of the grant application:

	Yes	No
Does the school/organization currently have a grant writer?

	Yes	No
Most grants require an authorized signature (usually the Principal's at the school level); has this person approved the submission of this grant?

How did you hear about our grant support services?

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