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)