EMPOWER LETTERS.PDF

Stipend Request Form January 2014
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Edison
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ14475-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
Funds rri for lin, Pn .'ect was made possible by the Centers for Disease Control (CDC). Arizona Department of Health Services is a subawardee to Nemours. who is
currently fun :Li: b.; the CDC under a five-year Cooperative Agreement (1t158DPCirJ4102) to support states in launching Ea learning collaboistivusfotu or si sity
prevention. Its contents are sinlehi/ the cesponsibility of the authors acid do not necessarily represent the official \leo/sof the Departmeht of Health and Human Services,
Centers or DS, rise Control awl Prevention, or the H.S. Doveritment,

Stipend Request Form —January 2014
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First Presbyterian Church
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ28280-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
:tuntting t this pFCs:loct was made possill.? by the Centers for Dise.ase (=ontrol tCDC), Artzona Department of Health SeV ,fiCe iC a sulsawadee ro kisanottis, ....tzt is
cut •ntly funchl.d by the CDC ender tr.tti•tarto Coo,:tetative Agreement :11..15811.)P111102) hi pport states in launching itCE leai•ning collaboratives Ica ut • ....is ol ity
, itt,ention. Its cur. dc are solely (')f the authors and do not necessarily represent the officiat views of the Department of Heatth and Human Services,
<:;c1.0 ,-Ts for Ditease Conti CA and Pre ,,,,n:1, 1.., or the U.S. Government.

Stipend Request Form January 2014
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Holmes 2
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify `make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ50272-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
Fnn , Jno for thin. Rhoject was made possible by the Centers for Disease ConV I (CDC) Arizona Department of Health Services is a sttbawaee to Nemouts, who is
cunt:nth., tuneted by the CDC under a five .yeav Coopeathze Agreement (1U58DP004102) to support ',Tates in launching ECE teaming colaboritive5 frsu obesity
prevention. its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Sertnces,
Centet 5 tor Dketse Contto! and Prevention, or the US. Ctovemment.

Stipend Request Form —January 2014
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Jordan Elementary School
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ85162-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
Fundii.i4 for im nth was made possible by the Centers for Disease Control (CDC), Arizona Department of Health Services is a sohawardee to Hem it who Iti
currently fun ,ei.i by the CDC under a five )year Cooperative Agreement f1ti58DPG04102) to support states in launching ICI learning coilaborathiesfocust - on obesity
preventS-.m. Its .. ats are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services,
Centers kir Viso.. s:'Contrizi! and Prevention, Ot the U.S. Government.

Stipend Request Form January 2014
Type or print legibly
La Mesita
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ77316-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
r thk project was made possible by the Centers for Disease ContrQI ',CDC). Arizona Department of Heatth Set VIC(.5 is a subawardee to Nen -,
curtntly funded by the CDC under a five-ear Cooperative Agreement (1 U5PiriP00 ,1102") to rapport states in launching ECE learning cottaborativefoi ..besity
pnention ttcorrteuts .ire solely the responsibility of the authors arid do not eecssaiily represent the official views of the Department cif Health and Human Services,
Centeri. [yvette Control and Prevention, On the US. Governmeut.

Stipend Request FormJanuary 2014
Type or print legibly
North Tempe 1
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ70727-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
l'uring for this pr'o)60-....,,I.1!;mado possible by the Centers for Disease Control (CDC). Arizona DTparttnent of Health Ser -vs is a subawardee to Unmoor who is
currently hinckd by rho CDC undtr five-year cooperative Agreement ( US POO4S2 to 5!.11)Fg.',1 -t states tr launching EC1 learning collabofativs one on obesity
prevention, Its contents, ire sc4ly the responsibility of the authors and do not necessarily represent the official views of the Department of Health and litin -;an Services,
Centers for Disease Control and Prevention, or the US. Government.

Stipend Request Form —January 2014
Type or print legibly
North Tempe 2
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
4Z474 25-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
Funding for the project was made posslble by die Centers for Disease Cant ((DC). Arizona Department of Health Services is a subawardee to Hem •J who is
currently funded by the CDC. unties a tive-yeat Cooperative Agseensent (1U58DP004102) to support states in launching EU. learning collaboratives focused on obes.i,
pres,:Jrition. its contents are solely the responsibility of the authors and donut necessarily represent the official views of the Department of Health and Human Services,
Centers for Disease Control and Prevention, or the US. Government.

Stipend Request Form anuary 2014
Type or print legibly
Porter
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ97368-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
Funding lothGv projec was made porgible by the Centers for Disease Controi ;CDC). A02.ona Department of Health Services is a subawardee to Herr a
currently (uncle,: by the CDC unckf a lye -year Cooperative Agreement Li58DP004102 .) to support states in launching ECE learning collabordtlyesfo.'w
prevE.ntion_ Its contents solely the riiwonsibilgy of the authors and do not necessarily represent the official views of the Department of Health and Human S erVJC.eS,
Centers for Dis.E'ase Control and Prevention, or the U.S. Government.

Stipend Request Form —January 2014
Type or print legibly
Taft
Name of Program
If check should be made Maricopa County Read Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ99334-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
rnolinq tor Mb project was made possible by the Centess for Disease Control Koo). Arizona Department of Health Services is a subawardee to hien - Ati, ohois
CL:Fre.ntly funded by the Cr( undei a five -year Cooperative Agreement (11.158DE '004102) to support states in launching ECE k:Arn4ig collaboratives focused . . hesity
prevention_ its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Departinent of Health and Human Services,
Ceraters for il)leas,L= Control and Prevention, or the U.S. Government,

Stipend Request Form —January 2014
Type or print legibly
Westside Generational Center
Name of Program
If check should be made Maricopa County Head Start
out to name other than
Program listed above,
please specify 'make
payable to' here
2150 S. Country Club Dr. Suite 7
Mailing Address Mesa AZ
85210
Street Address
City
Zip Code
AZ34349-02
Unique ID #
Maureen Mason
Name of person
completing this form
For Office Use Only
Check Number
Date
fiborieg this project suns made possible by the Centers for Disease Control (CDC). Arizona Department of Health Services is a subawardee to Nemours, who is
cur rentiy ftintlecl by the CDC under a five-year Cooperative Agreement LI58DP004102) to suppcirt states in launching ECE learning cellaboratives or I shy
prevention, its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Cervices,
Centers for Drseose Control and Prevention, or the U.S. Government.