Higher Education Incentives Program Form

2010-2011 Higher Education Incentives Program
Deadline: June 30, 2010

Biographical Information:
Name of Principal Investigator:
Title: First: MI: Last:
Institution: Title/Department:

Address:
Street: City: State: Zip:
Phone (XXX-XXX-XXXX):
Email: Confirm Email:
I affirm that I am a US Citizen: Yes

If you are not at the above address during the summer, please fill out the following:

Address:
Street: City: State: Zip:
Phone (XXX-XXX-XXXX): Email:

Fiscal Officer:
Title: First: MI: Last:
Phone (XXX-XXX-XXXX): Email:

Proposal Information:
Title of Project: (limited to 75 characters)

WSGC Funds Requested: (no commas) $ Proposed match(1:1 minimum): (no commas) $
Source(s) of Match:

Projected Time Frame: (mm/dd/yyyy) to
Location of Project:
Primary Field of Interest: If Other:
Secondary Field of Interest: If Other:

Synopsis:
Please include a short synopsis of your project (no more than 200 characters, including spaces and punctuation) outlining its purpose in terms understandable by the general reader. If your project is selected for funding, this wording will be used on our website.

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Proposal Requirements

Upload in Microsoft Word, Excel, JPG, or PDF format only.

Upload your proposal file:

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