Small Change that changes lives

FLINT ENERGIES FOUNDATION, INC. Post Office Box 308 Rey nold s, Georgia 31076-0308 478-847 -5113

Instructions for Completing Application

(1) Please type application, if possible; (2)Include a copy of your most previous years financial statement; (3)Provide a copy of your Internal Revenue Service Letter or Form showing 501(c) tax status; (4)If you are requesting funds to buy a specific item, please include a cost estimate in addition to a detailed description of the item; (5)Funds will not be granted for general operating expenses or utilities; (6) Mail your completed application, along with 12 copies to: Susan Poole, Flint Energies Foundation, Inc., P. O. Box 308, Reynolds, Georgia 31076-0308. After application has been received and reviewed by Flint Energies Foundation, you will be contacted relative to a date to appear before the board to make a brief presentation (five minute maximum). NOTE: If you have received a previous grant, your current request is more apt to be denied or rejected if you reapply prior to the lapse of 24 months; however, applications will be considered after the lapse of 12 months.

APPLICATION FOR DONATION (ORGANIZATION/AGENCY)

(Pl ease Type Info rmation)

1. Name of Organization: 2. Address: 300 Mary Ln

Warner Robins
(City)

Shirley Hills Elementary Media Center

(Street or Post Office Box)

GA
(State)

31088
(Zip Code)

3. Contact Person: Blair Young

(Name)

Media Specialist (Student)

(Title)

4. Telephone Number 5. Fax Number:

478-929-7824
(Work) (Home)

(478) 929-7121

6. E-mail Address: jy00323@georgiasouthern.edu

Website: http://www.hcbe.net/schools/shirley-hills-elementary-school.aspx

7. Is organization that is requesting funds exempt from paying income tax? yes If yes, please attach a copy of Internal Revenue Service letter or Form 501(c) to verify this distinction. Applications will not be processed without this information. 8. Please provide a copy of the most previous years financial statement(s). See Attached

9. Please list the counties that this organization serves. And, where possible, please breakdown the number of individuals, families or groups that this organization served last year in the following counties: Bibb, Chattahoochee, Crawford, Dooly, Harris, Houston, Macon, Marion, Monroe, Muscogee, Peach, Schley, Sumter, Talbot, Taylor, Twiggs, Upson. Houston County
More than 500 students and their parents; 68 members of the faculty and staff

10. Does organization serve needs outside the counties mentioned previously? If yes, provide information on the number served and locations. No

11. State specific purpose of your organizations/agencys request. (Include amount requested and specific details on how funds will be used. Include cost estimates for contract work or equipment purchases.)
See attached Purpose of Request

12. List other sources of funding that you have secured to meet the above request.

None. Our funding was cut this year, so our principal will not give money for technology.

13. How do you measure the effectiveness of your programs? (1) Parent, student, and teacher surveys
(2) Pre and Post data analysis of test scores (3) Formal and informal classroom assessments

14. Has this organization ever received funding from the Flint Energies Foundation? If yes, please provide an itemized statement of how those funds were used and attach it to this application. No 15. Please list three references. 1.Jamie Oliver, Instructional Tech. Coordinator
Name

(478) 808-1634
Telephone

300 Mary Ln
Address

Warner Robins, GA 31088

City State Zip Code

2. Dr. Traci Jackson, Principal

Name

(478) 929-7824
Telephone

300 Mary Ln
Address

Warner Robins, GA 31088

City State Zip Code

3. Tonya Copeland, Bookkeeper and Ecology Crew Sponsor

Name

(478) 929-7824
Telephone

300 Mary Ln
Address

Warner Robins, GA 31088

City State Zip Code

This information is for the purpose of obtaining funds from the Flint Energies Foundation, Inc. on behalf of the undersigned. Each undersigned understands that information provided herein is used in deciding to grant funds, and each undersigned represents and warrants that information provided is true and complete and that the Flint Energies Foundation, Inc. may consider these statements as continuing to be true and correct until a written notice of change is provided. The Flint Energies Foundation, Inc. is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. The Flint Energies Foundation, Inc. Board of Directors makes donations from funds collected through the Flint Energies Operation Round-up Program. These funds are voluntary contributions from participating Flint Energies customers.

Shirley Hills Elementary Media Center

Additional pages or documentation can be attached to application. Applications should be mailed to Susan Poole, C/O Flint Energies, Post Office Box 308, Reynolds, Georgia, 31076
FEFI Form 002 R 4/02

Name of Organization

Blair Young
Signature of Representative
11/9/11

Date

Purpose of Request Shirley Hills Elementary School is lacking in instructional technologies. This school is behind on advanced technology for student learning. Many of the students at Shirley Hills Elementary come from low or middle income families who often do not have the means to provide opportunities in the home for a solid technology-literate foundation. Adding technology will meet the needs of all learning styles and as educators, we will be able to show our students how technology can benefit them now and in the future. Our students need extensive interaction with technology on a daily basis to ready them for a technology-rich future. Supplying students with technology at school will provide them with the necessary skills to succeed at every educational level. Apple provides many free and low cost applications that may be downloaded onto the device. These applications will increase student achievement by providing fun and engaging programs to extend the learning of curriculum requirements in all areas language arts, math, social studies, and science. The devices are small and easy to handle and navigate. I would like to purchase the Apple iPod bundle for education. The iPod Learning Lab comes with 20 iPod Touch devices and a rolling cart to house, sync, and charge all of the devices at once.

The cost is listed below: Apple iPod Learning Lab Includes: 20 8GB iPod Touch Devices Bretford PowerSync Cart Shipping TOTAL $5,999

Free $5,999

Apple iPod Learning Lab

The Apple iPod Learning Lab provides schools with flexible, affordable, and convenient access to mobile technology. Each lab includes 20 iPod touch devices and a sturdy and secure mobile cart. The cart can store and charge up to 40 iPod

devices, sync up to 20 devices at a time to the same computer, and store up to four MacBook computers as well as iPod accessories. With the iPod touch, students have access to the Internet, a suite of productivity tools, educational apps, digital books, and core curriculum content, in a mobile, media-rich style that lets them learn as they live - on the go. And with the Apple iPod Learning Lab, educators have a streamlined way to manage multiple iPod devices in the classroom.

From: http://education.apple.com/ipod_learning_lab/ This site also gives the prices and can continue to a proposal from Apple for your school.

More about the iPod Touch: http://www.apple.com/ipodtouch/features/

Financial Report for Shirley Hills Elementary Media Center 2010-2011

Allotted State Funds Funds are allotted based on principal discretion. We are allowed to spend half of our first semester, and the other half is reserved for the second semester. Some media center funds were re-directed at the end of the second semester to cover over-spending from the general school allotment. QBE Sate Fund Allotted for the whole year: $6,786

1st Semester Purchases: World Book Online Subscription: $595.00 Garrett Books (84 non-fiction books): $1,372.74 Accelerated Reader Quizzes: $95.15 TOTAL Purchases for 1st Semester: $2,058.89 2nd Semester Purchases: Portable Barcode Scanner (inventory): $1,466.00 Penworthy Book Co. (15 books): $274.87 (After this, all state funds went back to the school budget) TOTAL Purchases for 2nd Semester: $1,740.87

TOTAL YEAR PURCHASES: $3,799.76 (Funds re-directed to school budget: $2,986.24)

Book Fair and School Fundraising Funds

1st Semester Funds Available Beginning Balance: $318.98 Profits and Funds Raised: $1,347.25 Total Funds Available: $1,666.23 Purchases 1st Semester: BTSB Books (15 Dr. Seuss books): $194.42 Highsmith (supplies): $116.49 Follett order (33 books): $435.58 Total Purchases for 1st Semester: $762.38 2nd Semester Funds Available: Balance forward: $903.85 Book Fair Funds Raised: $1,651.90

Total Funds Available: $2,555.75 Purchases 2nd Semester: Highsmith (supplies): $415.68 Highsmith (magazine spinner): $93.82 S&L Sales (books): $145.66 Demco (decorations): $131.10 Follett (books/DVDs): $727.55 National Library Bindery (re-bind old books): $134.45 Total Purchases for 2nd Semester: $1,648.26

TOTAL PURCHASES FOR YEAR: $2,410.64 Balance Forward to next year: $907.49 (The surplus will enable us to buy books to start the new school year).