Innovative Practice Funding Request - Basic Skills Initiative, Student Success & Support Program, and Student Equity

In our effort to integrate and align SSSP, BSI, and Equity resources and support innovative student success and equity practices across the campus, SS&E has developed this funding request application to assist with your request for funding.

Our integration effort is intended to leverage innovation resources with the goal of making our efforts more efficient and sustainable. This form will help you to develop, implement, and report the outcomes of your innovative practice or program. If you have any questions, please contact Ailene Crakes (SSSP), Larry Maxey (Equity), or Wendy Smith (BSI).

If you need funds for a professional learning activity, including Conference and Travel, please apply to the Campus Employee Learning Committee (CEL) first: http://www.emailmeform.com/builder/form/r08f7hya9c5wS59zvJ47

Email address
Today's Date
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Name of the Requestor (First Name, Last Name)
Your answer
Department
Your answer
Phone Number or Extension
Your answer
State the activity being proposed.
Your answer
Describe the activity being proposed.
Your answer
Has this initiative and/or activity been funded in the past?
Select the applicable goal area/s that supports the proposed activity.
Required
Provide a brief description of how the proposed activity is related to the applicable goal and/or area checked above.
Your answer
What are the desired outcomes as a result of the proposed activity, and how will they be assessed?
Your answer
If applicable, indicate the data source to be used for collecting data i.e. MIS Data, SARS, surveys, etc.
Your answer
Discuss how the proposed activity supports integration efforts.
Your answer
Discuss the long-term projections for what this request is accomplishing.
Your answer
How often will progress of the proposed activity be measured and evaluated? Discuss the details.
Your answer
Indicate the funding being requested.
Complete the itemized budget below (if applicable):
Your answer
Indicate amount being requested.
Your answer
Presenter/Speaker Fees
Your answer
Food/Beverages
Your answer
Materials
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Travel/Lodging/Transportation
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Other
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A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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