Launch Pad Step 1 of 10 - General Information 10% General InformationProject Title Request Submitted by Extension Department DeanCatherine Page, Dean of NursingDr. Alice Mecom, Dean of Communications & LanguagesMichael Garabedian, Dean of Library & Instructional SupportDr. Melba Castro, Dean of Outreach & Educational PartnershipsDr. Vann Priest, Dean of Mathematics, Science & EngineeringGita Runkle, Dean of BusinessGrant Linsell, Dean of Arts and Cultural ProgramsMark Yokoyama, Dean of Public SafetyMike Slavich, Dean of Career & Technical Education / Instructional OperationsYolanda Emerson, Dean of Kinesiology, Dance & AthleticsDr. Adam Westman, Dean of Behavioral & Social SciencesLisa Chavez, Dean of Counseling Project TeamDirector/Coordinator Extension Division Writer (if different) Other Grant Team Members Other Grant Team Members Grant Program Title Grant Number Has a specific grant opportunity been identified for this project? Yes no Who is the funding source? Funding Agency Federal State Foundation Other List Other Funding Agency(s): Proposal Deadline MM slash DD slash YYYY Total $ RequestedPerformance Period Number of Months/Years Partner Organization Project DescriptionWhat specific need or problem will the project address?Who will the project serve? How many?How will the project indentify them?What are the project's objectives and expected outcomes?Where will the project be carried out?How will you measure success? Data Collection RequirementsWhat kind of data will you need to support this grant application?Where are you planning on obtaining this information?Do you know what kind of evaluation design is required? Yes No If you answered Yes to the previous question please describe what data or information will be required to support the evaluation:Will you be doing an internal or external evaluation? Internal External If this project requires external evaluation please describe what type of support will be required from IRP to the external evaluator: Explain how the project relates to college and/or your division plan?List those activities expected to continue after the grant ends:How will the activities be supported?Indirect CostsWhat is the maximum percentage allowed by the funding agency? Matching FundsAre matching resources required? Yes No If yes, what is the estimated funding match amount?Please indicate the source College Other If other, please list source Please indicate which Cash In-Kind PersonnelWill there be any grant-funded staff? Yes No Staff Classification Certificated Classified Consultant CertificatedPositionTime Needed ClassifiedPositionTime Needed ConsultantPositionTime Needed FacilitiesList the facilities and/or equipment the college will need to provide for this project: InstitutionalizationWhat is the effect on the college and/or division if the project is continued (institutionalized) after funding (i.e. new curriculum developed, increased FTE’s by X%, need funds for software maintenance, need funds for grant staff, etc? Mark all that apply: FTE Curriculum Staff Changes Facilities Other Other - Describe:Additional Information/Comments? Please include them in the space provided below: To trigger the review process, please accept the statement, sign, and save the form. The Grant Development Department will review and contact you shortly with further instructions.SIGNATURE OF SUBMITTIERBy checking the box in this section of this Rio Hondo Launch Pad online document I, (1) acknowledge that I have followed the policies and procedures of the Office of Grant Development and Management to the best of my ability to complete this form, and (2) certify that the information I have provided on this form is complete and accurate to the best of my knowledge; and (3) I acknowledge that by checking the box in this section it is a representative act of my sole signature and not that of any other individual.Accept Statement I Agree Signature of Submitter Grant Development Department Use Only* Grant Launch Pad Reviewed SIGNATURE OF DEAN: By applying my electronic signature in this section of this Rio Hondo Launch Pad online document I, (1) acknowledge that I am aware, permit and support the activities described in this form by the submitter, and (2) I acknowledge that the activities described in this form are both in alignment with the goals and objectives of this institution, and in alignment with the departmental goals and program(s), and; (3) I approve this submission for further pursuit of Grant Funding by continuing further with the policies and procedures of the Office of Grant Development and Management.SIGNATURE OF DIRECTOR OF GRANT DEVELOPMENT AND MANAGEMENT: By applying my electronic signature in this section of this Rio Hondo Launch Pad online document I, Michaela Brehm (1) acknowledge that I have enforced the policies and procedures of the Office of Grant Development and Management to the best of my ability to assist in completion this form with the submitter, and (2) certify that the information I have added to, edited, enhanced, or provided on this form is complete and accurate to the best of my knowledge.NameThis field is for validation purposes and should be left unchanged.
