Requestor Information

Requestor’s Name: Date:

Contact Information:

Title:

Office Phone Alternate Phone:

Division or Department Name: Dean:

Preliminary Grant Funding Information:

For what purpose do you want grant funds?

How does this project align with the needs or mission of the college?

Have you ever received and operated a grant? Yes No

If yes, please explain purpose of grant and who funded it

What specific goals and objectives do you want the grant to support?

Do you know the amount of revenue needed for the project? Yes No

If yes, please explain how you determined the amount:

Do you have a funding source identified? Yes No

If yes, please identify:

What is the deadline for submission?

Other information