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William A.

Minor Grant Program


Application Form
Cover Sheet

PROJECT TITLE:

PI # 1 NAME PI #2 NAME

POSITION/TITLE/DEPARTMENT POSITION/TITLE/DEPARTMENT
MAILCODE MAILCODE

PHONE NUMBER PHONE NUMBER


EMAIL ADDRESS EMAIL ADDRESS

INSTITUTIONAL APPROVAL REQUIRED? Human Subjects ___Y


___N __N/A
If Yes, Approved? ______Y _____N ____Submitted Date
Submitted ___/___/_____
Dates of Proposed Period of Support
Funds Requested $

SIGNATURE OF PRINCIPAL DATE


INVESTIGATOR(S)

SIGNATURE OF CHAIR OR OTHER DATE


SUPERVISOR

DEAN’S OFFICE USE ONLY


Date of Application Receipt: Received by:

Application Complete Six Copies? Y___ N____


Y____N_____
II. PROJECT ABSTRACT

A. Project Description(MAXIMUM: 250 WORDS)

B. Project Significance and Impact (Maximum 250 words)

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V. ITEMIZED BUDGET

PRINCIPAL INVESTIGATOR(S) MCMA MINOR AWARD NO.


(office use only

ADDRESS FUNDS FUNDS


REQUESTED APPROVED BY
MCMA MINOR
GRANT
COMMITTEE
Nonexpendable Expenses

Commodities (Materials and


Supplies)

Travel (to Research Sites only)

Contractual Services

Automotive (rental of
University vehicle or transit
tickets)

TOTAL