Name:

Department:

Phone #:

Email:

Proposed Project:



Type of Project (mark all that apply):

	Grant-Funded
		I have funding for this project.
		I will seek funding for this project.
		Not Grant-Funded
		Service-Learning Project

Types of partnering organizations (ex. youth organizations, anti-hunger nonprofit, local government):

Are you seeking additional faculty partners?
yes no

If yes, what department(s) are you interested in working with: