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School Tax ID #
Bryce Kennedy Memorial, Inc.
The Texas Alcoholic Beverage Commission (TABC) reports that alcohol is the number one drug
of choice for teens in America. In 2005, teen alcohol sales accounted for 15% of the national
alcohol sales. In 2006, an estimated 17,602 people died in alcohol related crashes. An estimated
3 out of 10 people will be involved in an alcohol related accident at some point in their lives.
Communities cannot afford to ignore the devastating impact that underage drinking is causing.
There is an ongoing need at the local level to provide programs to teens such as the Shattered
Dreams program that promote awareness and prevention of underage drinking and drinking and
driving.
Bryce Kennedy was one of two passengers killed by a drunk driver on October 1, 2006. In
memory of Bryce and in an effort to prevent other families from living this tragedy, Bryce
Kennedy Memorial, Inc was formed to provide funding to high schools to conduct Shattered
Dreams programs. We can make a difference in our community.
Grant Application Packet
Table of Contents
I.
Eligibility and Restrictions
II.
Application Guidelines
III.
Grant Application
IV.
Grant Contract
V.
Reimbursement Instructions
VI.
Sample Invoice
VII. Record of Activities
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Eligibility and Restrictions
 Any High School may apply. Other groups wanting to have a Shattered Dreams
program please contact Bryce Kennedy Memorial.
 An officer of Bryce Kennedy Memorial Inc. and the high school principal or assistant
principal must sign the grant contract before the Shattered Dreams program is
conducted.
 The Shattered Dreams program must be completed during the current school year.
 To be eligible for funding, an original application must be signed and mailed to Bryce
Kennedy Memorial Inc.
Application Guidelines
 Complete the Application form.
 Complete Grant Contract. Contract must be dated before the event. Any contracts
not dated before the event will not be honored.
 Mail to:
Bryce Kennedy Memorial Inc.
PMB 163
2438 Industrial Blvd.
Abilene, TX 79605
 Bryce Kennedy Memorial Inc. will contact your school’s contact person within 30
days of receipt of application with approval or denial of funds. For questions please
email [email protected]
For More information, contact Don or Shawn Kennedy at 325-691-0758
or email [email protected]
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Grant Application
Name of High School: ____________________________________
School District: _________________________________________
Address: _______________________________________________
Principal: ______________________________________________
Phone: _____________________________________________
Fax: _______________________________________________
Email: _____________________________________________
Name/Title of Contact: ___________________________________
Phone: _____________________________________________
Fax: _______________________________________________
Email: _____________________________________________
1. Projected date of program: ___/____/____
2. Type of school: □ Rural □ Urban □ Suburban
3. Total number of student population: ___________________________________
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4. Estimated number of students participating in program? ____________________
5. Is your school planning to continue youth-alcohol awareness after the Shattered Dreams
program? If yes, describe.
□ yes □ no
6. List other school-based activities/programs related to underage-drinking issues that your
school has participated in within the past three years.
7. How many students at your school have been killed or seriously injured in the past three
years in auto crashes? (Include all crashes, not just alcohol related crashes.)
8. Reason(s) for interest in the Shattered Dreams program:
□ Homecoming
□ Prom
□ Graduation
□ Spring Break
□ National Drunk and Drugged Driving Month, Alcohol Awareness Month
□ Alcohol related tragedy/student death
□ Student Concern regarding alcohol by peers
□ Community concern regarding underage drinking/DUI
□ Other:
9.
Has your school ever participated in a Shattered Dreams program? If yes, when was
the last time? Please explain:
10.
If you do not receive funding to assist with your event, will your event happen?
11.
What do expect your school to gain by participating in the Shattered Dreams program?
12.
Is your school prepared to meet all the requirements needed to fulfill the obligations to
be eligible for this grant?
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Grant Contract
(Name of High School)
__________________________________________________│____________________
(Contact Name)
(Phone Number)
(Mailing Address)
(Grantee, Principal or Assistant Principal)
Purpose
Bryce Kennedy Memorial Inc. was formed to fund to youth activities or events designed to
educate young people in making better choices related to underage drinking, drug use, and
drinking and driving.
Agreement
1. Grantee agrees to conduct a Shattered Dreams program.
2. Bryce Kennedy Memorial Inc. agrees to provide a one time reimbursement for up to
$2000 (if there is a special need for more funds please talk to us) for program related
expenses. If shirt sizes are provided Bryce Kennedy Memorial will provide T-shirts for
the participants of the Shattered Dreams program including students, teachers and other
support.
3. The grantee’s Shattered Dreams program should contain the minimum components as
detailed in the Shattered Dreams manual (copies available on website):
 a mock crash scene
 the “living dead”
 the TABC Parent Shattered Dreams Program
 a student overnight retreat
 an assembly for students and parents
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 Display of a banner at the assembly that states the event was sponsored in part by a
grant from Bryce Kennedy Memorial Inc.
4. The grantee agrees to use the grant funds for the purpose of holding a Shattered Dreams
event as defined in this document.
5. The grantee agrees to provide Bryce Kennedy Memorial Inc. with a report on activities
conducted, a picture of the students in front of the banner, and a copy of the DVD
produced by the videographer.
6. The Grantee agrees to comply with the General Provisions.
7. The Grantee shall remit an itemized invoice within 45 days after completion of the
Shattered Dreams program.
8. The Grantee shall save harmless Bryce Kennedy Memorial Inc. from all claims and
liability due to activities of himself, his agents or employees performed under this
agreement and which result for an error, omission or negligent act of the Grantee or any
person employed by the Grantee.
9. The Grantee shall also save harmless Bryce Kennedy Memorial Inc. from any and all
expenses, including attorney fees, which may be incurred by Bryce Kennedy Memorial
Inc. in litigation or otherwise resisting said claim or liability which might be imposed on
Bryce Kennedy Memorial Inc. as the result of such activities by the Grantee, his agents or
employees.
10. Bryce Kennedy Memorial Inc and the Grantee shall not assign or otherwise transfer its
rights or obligations under this agreement except with the prior written consent of the
other party.
11. Upon completion or termination of this agreement, all documents prepared by the
Grantee or furnished to the Grantee by Bryce Kennedy Memorial Inc. shall be delivered
to and become the property of Bryce Kennedy Memorial Inc. All data prepared under this
agreement shall be made available upon request to Bryce Kennedy Memorial Inc. without
restriction or limitation on their future use. The Grantee may, at his own expense, have
copies made of the documents or any other data he has furnished to Bryce Kennedy
Memorial Inc. under this agreement without restriction or limitation on their future use.
The Grantee
By:
Bryce Kennedy Memorial Inc
By:
__________________________
_________________________
Principal or Assistant Principal
Signature of Administrator or Designee
_________________________________________
Print or Type Name/Title
_______________________________________
Print Name
_______________________________
Date
_____________________________
Date
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Reimbursement Instructions
1.
The original invoice must be on official school letterhead. Use the sample invoice
format to expedite the process
2.
The principal or assistant principal must sign the original invoice
3.
Attach the original invoice to the Report on Activities form.
4.
Provide a copy of the DVD of the program and picture of students in front of banner.
5.
Submit within 45 days after completion of the program.
[Use official letterhead of your high school]
SAMPLE INVOICE
Quantity
Item
Total
[actual
amount
spent, up to
$2000
1
[Itemize purchases]
Total
[No more
than $2000]
I certify the above invoiced goods and services were purchased
expressly for the Shattered Dreams program and that the purchases
comply in every way with the contract under which they were
purchased.
___________________ _________________
______________
Signature
print name/title
Date
Under special circumstances grants greater than $2000.00 may be obtainable.
Make Check Payable to: [name of high school]
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Report of Activities
School Name:
Day(s) and Date(s) the Shattered Dreams program was held:
Number of students actively involved in the program:
Number of parents involved:
Estimate the total number of persons involved in planning/presenting the program (including
students, present teachers, community numbers, etc.)
1. Community members/others involved planning and presenting the program (check all
that apply):
a. □ TABC
b. □ Parents
c. □ Community groups (Boys and Girls Club, Rotary, etc)
d. □ School officials (i.e. teachers, principals, coaches, counselors, etc.)
e. □ School board members/local politicians decision makers
f. □ Media/reporters
g. □ Local businesses
h. □ Hospitals/medical personnel
i. □ Emergency medical services
j. □ Fire department
k. □ Police/sheriff’s department
l. □ Courts (judges, prosecutors)
m. □ Funeral Home/Medical Examiner’s office(s)
n. □ MADD/SADD or related organizations
o. □ Other: (Please specify) ______________________________
Components of your school’s Shattered Dreams program (check all that apply):
□ 2008 “TABC Parent Shattered Dreams Program”
□ Student presentation hosted by TABC
□ Mock Crash scene
□ Living dead (i.e. Signifying the number of people injured or killed in alcohol-related
crashes by having students wear black/paint their faces and not communicate during the
school date)
e. □ Parent death notification of mock student deaths
f. □ Arrest/adjudication of DUI offender
2.
a.
b.
c.
d.
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g.
h.
i.
j.
k.
l.
m.
n.
□
□
□
□
□
□
□
□
Survivor or student counseling/debriefing
Medical treatment of crash victim(s) at a local hospital/emergency room/clinic
Retreat
Letters to parents/friends from the “dead”
Victim(s) funeral/memorial session and/or school assembly
Video production of events
Hospitality and media room/press briefing
Other: ___________________________________
3. How effective do you think your program was in preventing underage drinking and
relaying the consequences of drinking and driving to the following:
Students directly participating in the program
Very
Effective
□
Effective
□
Only Somewhat
Not
Effective
Effective
□
□
Students observing the program
□
□
□
□
Parent’s
□
□
□
□
School faculty/staff
□
□
□
□
Community member’s
□
□
□
□
It is important to Bryce Kennedy Memorial to have all
items on this contract complete so that we may learn
more about how Shattered Dreams is helping the youth.
Also to make sure that Bryce Kennedy Memorial is
providing the best support that we can both emotionally
and financially. Thank you for your participation.
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