This completed application form will be submitted to

All fields required.
Note: If planning more than one activity for the school, please submit once per activity.


Applicant email:

Application Date:

Title of Activity:

Date of Activity:


Committee Members (in consultation with staff and SRTA council representative):

Activity Description:

Physical Wellness Component:

Nutritional Wellness Component:

Mental Wellness Component:


Total amount requested: $

Cheque Payable to:

(if more than one recipient, please email and let the Chair know)