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)

2
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