Jerome Joint School District No. 261

COMMUNITY RELATIONS 4530F

Crowdfunding Request Form

Crowdfunding requests must be made via a fully completed copy of this form.

Contact Person

Name: ________________________________________________________________________

Job Title: _____________________________________________________________________

Phone Number: _____________________ Email Address: _____________________________

School: _______________________________________________________________________

Campaign Information

Crowdfunding Website to be Used: _________________________________________________

Target Amount of Fundraising and/or Items Requested: _________________________________

______________________________________________________________________________

Recipient Classroom, Program, and/or Activity: _______________________________________

Campaign Start Date: __________________ End Date: __________________

Please attach a copy of the exact language to be included in the post and/or advertising for the crowdfunding

campaign.

Signature of Applicant

I have read and agree to abide by Policy 4530 Crowdfunding. I understand that I must have the written permission

of the building principal before I begin this crowdfunding webpage or effort.

Name: _________________________________ Date: _______________________________

Signature: _____________________________________________________________________

Signature of Building Principal

Please select one:

_____ I have consulted the coordinator of technology and media service and the coordinator has confirmed the

technology-related items the crowdfunding effort seeks to obtain are acceptable.

_____ I have consulted the coordinator of technology and media service and the coordinator has deemed the

technology-related items the crowdfunding effort seeks to obtain unacceptable.

_____ This crowdfunding effort does not seek to obtain any technology-related items.

Please select one:

_____ I, the building principal, authorize this crowdfunding request.

_____ I, the building principal decline to authorize this crowdfunding request.

Name: _________________________________ Date: _______________________________

Signature: _____________________________________________________________________

Policy History:

Adopted on: 01/28/2020

Revised on: