Please print out, complete form and submit to your department manager

Grant Request Intiator:

E-mail:

Department:

Current Date:

Deadline for Proposal:

Funding Period (Dates) from:

to:

Potential Funding Sources:

What are the grant's goals and purpose?

How does that grant fit in  Abilities Center’s Mission Statement and current strategic plan?

What stakeholders are involved? Have they been involved in planning?

How will the grant improve/expand services?

What are the specific activities associated with the grant?

What outcomes are anticipated?

How will the outcomes be evaluated?

Who will benefit from the grant?

Are there any matching funds required from Abilities Center? If yes, list how much and any other restrictions.

Does the grant require any collaboration with other institutions? If yes, explain.

What other resources (space, personal, etc.) will be required to fulfill this grant?