Step 1: Application Form

Note: This form is for viewing purposes only. When submitting your application, please use the MSWord form. Download the MSWord form here.

Proposal

Title:

 ___________________

Requested Start Date (M/D/YY):

___________________

Duration in Months:

___________________

Funding

(enter details on Budget Form)

Amount Requested from the Fund for Darfur:

 ___________

Other Project Funding Received Total Amount:

 ___________

Other Project Funding Pending Total Amount:

 ___________

Total Estimated Project Cost:

 ___________

Project Leader, other Key Personnel, and Sponsoring Organization

(The information given below should correspond exactly to the person’s/ organization’s listing in a University of Chicago Directory or Web site listing of RSO’s.)

The Project Leader certifies that he/she is a University of Chicago student, faculty, or staff, and agrees to take responsibility for the conduct of the project and submission of a final report.

Project Leader

First Name:
___________________

MI:
___

Last Name:
___________________

Email address:
___________________

Key Personnel

First Name:
___________________

MI:
___

Last Name:
___________________

Email address:
___________________

First Name:
___________________

MI:
___

Last Name:
___________________

Email address:
___________________

First Name:
___________________

MI:
___

Last Name:
___________________

Email address:
___________________

Sponsoring Organization (as listed in a University Directory):

_______________________

Person Authorized to Commit the Sponsoring Organization in Financial Matters:

First Name
___________________

MI
___

Last Name
___________________

Email address
___________________

Have you previously received support from the Fund for Darfur?

If yes, please complete the information below:

Project Title:

 ___________________

Year of Award:

 ________

Project Leader:

     

First Name:
___________________

MI:
___

Last Name:
___________________

Email address:
___________________

When form is complete, proceed to Step 2.

View a description of the Project Narrative.