Program Innovation Fund ApplicationFallCall2017/18

Application FORM

Program Innovation FundFALL Call 2017/18

Application deadline: Friday, September 22, 2017

Note: Applicants must review the ‘PIF Application Guidelines’and ‘General Information’prior to completing the application. Be sure to complete all the appropriate sections, as incomplete applications will NOT be considered.

1.Project NAME

Title:

2.applicant(S)

Name: / Name:
Dept./School: / Dept./School:
Campus/Room #: / Campus/Room #:
Telephone: / Telephone:
Email: / Email:

3.ADDITIONAL PARTICIPANT(S) If project is dependent upon the work of other area(s)of the College(ie: TLTC, eTV, ITS, etc), youmust consult those area(s) and obtain appropriate response(s) to indicate their awareness and support.

Name: / Name:
Department: / Department:
Response: / YES, this project can be supported. / Response: / YES, this project can be supported.
NO, thisproject cannot be supported. / NO, thisproject cannot be supported.
Briefly explain: / Briefly explain:

4.ADDITIONAL APPROVALS/cONSULTATION: Does your project require approval/consultation from other area(s) of the College to verifyadherence to applicable College policies and procedures?You must consult those applicable area(s) before submitting the application. Discuss with your Chair or Manager.

List applicable departments that have been contacted:

5.PROJECT DESCRIPTION

5.1 What is the anticipated start date? / 5.2 What is the anticipated end date?
dd/mm/yyyy / dd/mm/yyyy
5.3 Objective of project: (indicate if this is part of a larger or ongoing project)
5.4 Relation of completed project to objectives and plan of the College & your department/program:
5.5Plans and methods to be used in carrying out the project.
5.6 Results and deliverables anticipated from the project:
5.7 Who is doing the work on this project?

6.BUDGET ESTIMATE

6.1 Staff
Does the project require position backfill?
No, backfill is NOT required
Yes, backfill is required / indicate the number of hours that will be required:
Salary Calculation(See Application Guidelines for calculation formula) / Initial Estimate ($)
Operating (e.g.: materials and supplies plus taxes and any shipping costs) / Initial Estimate ($)
TOTAL Amount Requested (to maximum $10,000)
Materials acquired with funds from this project are the property of Red River College.
Deans and Chairs will ascertain the storage and future distribution/use of materials acquired.
6.2 RevenuePotential
If revenue potential exists, provide a realistic estimation of amount and explanation.

7.PROJECT PLAN

Include a brief timeline, itemizing work to be accomplished at each stage or month as well as how much you expect to expense at each stage or month, to the completion of your project.

REQUIRED APPROVALS

When your part of the application is complete, forward it electronically to your Chair (or Manager)before the deadline.
CHAIR or MANAGER: Please include in your comments your plans for the storage and the future distribution/use of materials acquired.
Name:
Department:
Comments:

The Chair or Manager will forward the completed application electronically to their Dean or Director, by the deadline.

DEAN or DIRECTOR: Please comment on the above application in light of the criteria for Program Innovation Fund projects. Indicate its relation to the College’s objectives and plans, and your School’s plans.
Name:
School:
Ranking: / I rank this proposal number _____ of ______submitted from this School.
Comments:

Once ranked, the Dean or Director will forward the completed application electronically to:

PIF ApplicationJAN 2017Page 1 of 4