If you are requesting to use ECA funds, please read and complete this form.

    Arizona Revised Statutes (A.R.S.) §43-1089.01 defines an extracurricular activity as follows:
    Extracurricular activities are school sponsored activities that require enrolled students to pay a fee in
    order to participate. The activities must supplement the school’s education program and may be
    educational or recreational. Extracurricular activities may include: use of band uniforms, use of
    equipment or uniforms for varsity athletics, use of scientific laboratory equipment or materials, in
    state or out-of-state trips that are solely for competitive events. Extracurricular activities do not
    include any senior trips or events that are recreational, amusement or tourist activities.

    District personnel ONLY should complete this form. Students or parents should not complete this

    DO NOT complete this form if your request for ECA funds falls into one of the following categories:
   Elementary schools going on school sponsored Educational Field Trips.
   Secondary school athletic programs, such as, football, baseball, tennis, etc.
   Sponsors of Clubs that have a school charter on file and an established Student Funds account.
   Performing Arts groups, such as Band, Chorus, Drama, and Orchestra.

    If your request for ECA funds does not fall into one of the above mentioned categories, it is
    necessary to complete this form.

    Please answer the following ECA Questions:

    1. State law states that a student should pay a fee for an extracurricular activity in order to participate.
       Would the student be willing to pay a fee for this activity?                       Yes____ No____

    If the answer to question #1 is yes, then continue answering the following questions. If you answered
    no, then this activity does not qualify for ECA funding.

    2. Is the student required to participate in the extracurricular activity?           Yes____ No____

    3. Is the student going to be graded or tested on the extracurricular activity?      Yes____ No____

    4. Is the extracurricular activity part of the District or school’s curriculum?       Yes____ No____

    5. Is the extracurricular activity a recreational, amusement or tourist activity?     Yes____ No____

    6. Is the student going to receive any type of credit for this activity?              Yes____ No____

    7. Is this a non-school sponsored extracurricular activity?                           Yes____ No ___ _

    If you answered YES to ANY of questions 2 - 7, you will NOT be able to use ECA funds.

    If you answered NO to ALL of questions 2 - 7, complete page 2 of this form. After you have
    completed both pages of this form, give a copy of it to your secretary who handles Student Activities
    at your school. The secretary will fax a copy of this request form (both pages) to Student Activities –
    x20138. Student Activities will then notify the secretary as to the approval or denial of this request.


Date: ___________________ School Name: ___________________________________________

Name of Requestor: _____________________________ Phone #____________________________

ECA Account Name and Number: ____________________________________________________

Describe the purpose of your request for ECA funds. Be specific in identifying the extracurricular
activity: __________________________________________________________________________






How does the extracurricular activity supplement the school’s educational program?





The District will make the final determination as to whether or not ECA funds may be used for this
extracurricular activity.

All forms will be kept on file in Student Activities for review and informational purposes as needed
by the District, Internal and External Auditors and the State of Arizona.

By signing this form you are agreeing that you have read and are in compliance with the Mesa Public
Schools ECA guidelines. Requests will NOT be considered without a signature.

______________________________________________                 ______________________________
Signature                                                      Date

______________________________________________                 ______________________________
Please PRINT name                                              Title


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