Thiel College - Grant Request Form

FACULTY AND STAFF GRANTS REQUEST FORM

Date:	Dept:

Contact:	Telephone:

E-Mail Address:

A. THE PROJECT or PROGRAM
Project Name:	New Project? Yes No
Total project budget:	Total amount from grants:
Project timeline, if not an ongoing program:

Funding needed by:
Brief description of, and who will benefit from this project:

Overall goal in one sentence:
To
One or two core outcomes:

Criteria and methods of evaluation:

Who will be responsible for the evaluation?


B. THE FUNDING
Committed sources of funding this funding cycle, and amounts pledged or received, including in-kind contributions:


Have you identified any potential funders you would like me to pursue, or perhaps some have approached you?
Yes No If yes, please list them:


To your knowledge, which of these has funded this particular project or funds higher education projects?


Anything else I should know regarding the project?


Thank you for completing this form for funding. I will be in contact with you within 10 days regarding possible grantors, and/ or to gather additional information.

Roberta J. Leonard Corporate & Foundation Support 724.589.2024 FAX: 724-589-2860