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	GRACE ANN GEIBEL INSTITUTE - PROPOSAL
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Institute for Justice and Social Responsibility (IJSR) - Proposal for Support Funding

You must submit an intent form and have it approved before proceeding to the full proposal form. This happens twice a year at the dates indicated in the form (November and April). Also, if you need help, please contact Marilyn Coleman at 412-389-0196 or mcoleman@carlow.edu

This form must be completed during one sitting (you cannot save this form to work on it later). It is recommended that you answer all questions offline. (To do so, please answer these questions in a program such as Microsoft Word. By doing this you can save your answers in the Word document if you are unable to complete the form all at once.) Then, you can copy and paste your answers into the appropriate form fields to submit it online. Please open another browser window instead of navigating from this page. Otherwise, you may lose some of your information.

Section 1: Contact Info

1. Proposer Name:

2. Email:

3. Phone:

Section 2: Project Abstract

4. Brief description of the project
(50-75 words) :

Section 3: Project Parameters
Please identify key project limits.

5. Project Name:

6. Project Start Date:

7. Project End Date:

8. Target Population:
(whom it will help/affect)

9. Community Partners:

Section 4: Relationship to Institute Mission (brief but substantial answers)

10. How does the project address questions of justice, oppression and social responsibility?:

11. How does the project have potential to, or provide impetus for, creating systemic change?:

12. How does the project educate participants or the community, including Carlow students?:

13. What women-centered approaches does the project use, i.e. feminist scholarship; class-, race-, gender-based approaches; holistic blends of interdisciplinary studies; or inclusive studies?:

14. How does the project address issues important to the “un-included,” i.e., disenfranchised/ underserved/difficult-to-reach?:

15. How does the project further the tradition of the Sisters of Mercy and the Carlow University mission?:

Section 5: Methodology (brief but substantial answers)

16. How is the project participatory, i.e. involve the un-included, exchange information with/among participants, respond to a documented need, or consult the stakeholders?

17. How is the project reflective, i.e. consider the position (powers, values, bias) of the proposer, reflect on how the participants are represented, and/or include formative measures?

18. How is the project research-based, i.e. include an appropriate literature review and/or incorporate best practices/model programs?

Section 6: Project Plan

19. Goal (intended change):

20. Objective (major activity):

21. Measurable Outcome (product/change):

Tasks	Participants	Date Begin	Date End
a.
b.
c.
d.
e.

Section 7: Estimated Budget Detail
Please estimate the costs of the project, including in-kind and partner contributions

Expenses	Show Calculation of Cost Estimate	Row Subtotal
22. Salaries and Wages
Name
Name
Name
23. Payroll taxes
24. Fringe benefits and related fees
25. Consultant and professional fees
Name/type
26. Travel
27. Equipment
Item
Item
28. Supplies
Item
Item
29. Pringting and Copying
30. Telephone and Fax
31. Postage and delivery
32. In-kind Expenses (donated)
Type
Type
33. TOTAL expenses
34. TOTAL income
35. TOTAL from other sources
36. TOTAL requested from IJSR
37. Other support requested from IJSR (specify)

Section 8: Sustainability

38. Does this project need any continuing funding or support beyond this year?

39. How will future project costs/support be covered?

40. Upon acceptance of your proposal, would you agree to participate in a two-hour workshop on strategic planning and project sustainability?

Due Date (fall or spring):

Carlow University is accredited by the Middle States Commission on Higher Education, 3624 Market Street, Philadelphia, PA 19104. (267-284-5000)
The Middle States Commission on Higher Education is an institutional accrediting agency recognized by the
US. Secretary of Education and the Council for Higher Education Accreditation.