Student Affairs Program Coordinating Council Strategic Initiative Grant Program 2011-2012

All fields are required

Contact Information

First Name:
Last Name:
Phone Number:
Email:
UI Affiliation:

program/project

Title of proposed Project:
Proposed Date(s) of Event: (MM/DD/YYYY)
Proposed Time(s):
Location of Event (has venue been reserved?):
Target audience:
Expected number to participate in this event by subgroups(i.e., students, faculty, staff, community members, etc):
How will this event by publicized?:
Which student affairs strategic goal will be addressed by your project?:
What is the emerging issue you will address?:
What do you propose to do?(Please detail how the collaboration is integral to the success of the program)

Other Information

What is the educational component and/or learning outcomes you expect from your program?
What is the potential for long-term impact, change, or best practice?
How will this program ultimately have a positive impact on the greater student population?
How are the all the co-sponsors collaborating on this program?
What unit heads or their designees have been consulted about this program?
(Please include their email address, because we will contact them for verification) If funding for food is requested how is it integral to the program?
How is your program innovative?:
Have you been awarded SIG funds for this project in the past?:
Yes No If yes, how much was awarded?:
How much was disbursed?:
If yes, what other sources have you approached to fund this project in its second year?:
If yes, what is the minimum amount of funds that you need to continue the project for another year?:
If yes, rationale for continued support and plans for institutionalization of the program.

Project Length?

Is this a multi-year-project?
Yes
No

Proposed Budget

Requested From	Amount Requested	Amount Approved	Amount Pending
PROJECTED INCOME SOURCES, AMOUNTS, AND INFORMATION
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
PROJECTED EXPENSES, AMOUNTS, AND INFORMATION
PROJECTED EXPENSES	TOTAL BUDGET		SIG Request
Advertising	$		$
Decorations	$		$
Supplies	$		$
Program Printing	$		$
Equipment Rental	$		$
Space Rental	$		$
Honorarium for Speaker/Performers/Special Guest**	$		$
Transportation for Speaker/Performers/Special Guest	$		$
Lodging for Speaker/Performers/Special Guest	$		$
Meals for Speaker/Performers/Special Guest	$		$
Security	$		$
Food (only if integral to the program—and justified above)	$		$
Other (specify)	$		$
Other (specify)	$		$
TOTAL PROJECTED EXPENSES	$
GRAND TOTAL (projected expenses - approved income)	$
YOUR REQUEST FROM SIG			$
Minimum amount needed to carry out the project			$

Proposed Budget For Year 2

Requested From	Amount Requested	Amount Approved	Amount Pending
PROJECTED INCOME SOURCES, AMOUNTS, AND INFORMATION
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
PROJECTED EXPENSES, AMOUNTS, AND INFORMATION
PROJECTED EXPENSES	TOTAL BUDGET		SIG Request
Advertising	$		$
Decorations	$		$
Supplies	$		$
Program Printing	$		$
Equipment Rental	$		$
Space Rental	$		$
Honorarium for Speaker/Performers/Special Guest**	$		$
Transportation for Speaker/Performers/Special Guest	$		$
Lodging for Speaker/Performers/Special Guest	$		$
Meals for Speaker/Performers/Special Guest	$		$
Security	$		$
Food (only if integral to the program—and justified above)	$		$
Other (specify)	$		$
Other (specify)	$		$
TOTAL PROJECTED EXPENSES	$
GRAND TOTAL (projected expenses - approved income)	$
YOUR REQUEST FROM SIG			$
Minimum amount needed to carry out the project			$

**If a speaker/performer/special guest is being paid: a bio, vita, or press release info MUST be submitted. Please provide copies of all contracts or agreements with Speakers/Performers/Special Guests.** Attachments can be sent via email to Belinda De La Rosa (blarosa@illinois.edu) or hand delivered to 300 Turner Student Services. Application is due June 15, 2011 by 5pm.