HEALTH MATTERS

OFFICE OF HUMAN RESOURCES

CAMPUS INCENTIVE FUND PROPOSAL 2008 - 2009

Submissions will be accepted until May 30, 2008

Instructions: You can request a form by e-mailing Cassandra Kitko or you may print out this page by hitting the print button on your browser. To print the other two pages, go to the bottom of each page and hit the link to go to the next page. Hit the print button to print those pages, fill them out, and send them to:

Form A -- Title Page

Campus Contact:
Campus:
Campus Address:
Telephone Number:
Contact Email Address:
User ID of person completing this proposal:
 
Name of Administrator:
User ID of Administrator:
Title of Administrator:
This project/program must be approved by the Administrator listed above.
Checking this box verifies that the Administrator has approved this project/program.
 
Program/Project Title:
Projected Number of Participants:
 
Abstract of Proposal (limit to 750 characters):

Form B -- Project Summary

Please limit all answers on this form to 750 characters each. A character is a letter, space, or punctuation.

1. Rationale: Briefly describe why you want to offer this program.
 
2. Objectives of the Program: The program will enable participants to:
 
3. Program Delivery: How do you plan to deliver this program?
 
4. Program Timetable: Timetable for program implementation:
 
5. Evaluation Plans: All proposals should have an evaluation piece. It is required for the follow-up report. Briefly describe the evaluation piece you plan to use.

Form C -- Budget Proposal

Itemized Expenses (limit to 750 characters): Please show a list of your expenses.
 
Total Cost of Program: $
From the above total cost of the program, how much money from the Campus Incentive Fund is your campus requesting? $
From the above total cost of the program, how much support money is the campus providing for the program offering? $
From the above total cost of the program, how much is the campus recommending the participants contribute to the screening
(cost for each participant)? $
 

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