Application Faculty and Staff Community Engagement Award
Applications will be assessed in the following areas:
Merit of community engaged approach - highest possible rating 30 points
 Embodies the CPC definition of Community Engagement (5 points)
 Advances SLCC’s Community Engagement core theme (5 points)
 Responds to community-identified issue, opportunity, or need (5 points)
 Provides activities and implementation plan (5 points)
 Identifies measurable impact/outcomes (5 points)
 Identifies an assessment plan (5 points)
Potential - highest possible rating 30 points
 Potential impact on SLCC (15 points)
 Potential impact on the target community (15 points)
Budget - highest possible rating 20 points
Audience - highest possible rating 10 points
 Local (6 points)
 State (4 points)
 Regional (3 points)
 National (2 points)
 International (1 point)
Bonus - highest possible rating 15 points
 Involves cross-college collaboration (5 points)
 Demonstrates potential for sustainability/identifies future funding sources (5 points)
 Is a new initiative or includes a substantial innovation that increases the community engagement
component of an existing program (5 points)
For more information about the award, please see the Government and Community Relations website.
NEW IN 2015-2016: REQUESTS FOR FUNDING LESS THAN $2,000 MAY BE MADE AT ANY
TIME THROUGHOUT THE FISCAL YEAR. Funding requests greater than $2,000 must be
submitted by one of the following deadlines.
2015-2016 Award Cycles for funding greater than $2,000
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May 4, 2015
November 9, 2015
February 1, 2016
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Submit the award application to by email:
[email protected]
If submitting the award by email, please scan, mail, or fax the cover sheet with required signatures.
Submit the award application by fax:
801-957-4194
Submit the award application by interoffice mail:
Government and Community Relations, ATTN: CEAP, AAB 101M
APPLICATION STARTS ON PAGE 3.
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Section 1. Cover Sheet
Initiative Title __________________________________________________
Principal SLCC Staff or Faculty
Contact Information
Name:__________________________________________________________
Title:___________________________________________________________
Department: _____________________________________________________
Phone: _________________________________________________________
Email: __________________________________________________________
Principal’s signature and Date:
________________________________________________________________
Unit Head Signature (Dean or Vice President) and Date:
_________________________________________________________________
Supporting staff or faculty (name, title, department):
_________________________________________________________________
_________________________________________________________________
Community Partner
Contact information: ________________________________________________
Organization, Company, or Agency Name: ______________________________
_________________________________________________________________
Address:__________________________________________________________
_________________________________________________________________
Phone: ___________________________________________________________
Email: ___________________________________________________________
Budget Information
Amount Requested: _________________________________________________
Amount and source of additional funding for initiative (in current or future fiscal years) as applicable
__________________________________________________________________
__________________________________________________________________
Alignment with SLCC Community Engagement Goals (please check all that apply)
__ Contribute to economic and community development
__ Champion diversity and cultural enrichment in the community and the College
__ Provide community service and involvement opportunities
Type of Initiative (please check all that apply)
__ Community engaged classrooms (curricular community engagement, including but not limited to
service- learning)
__ Student leadership initiatives (co-curricular student engagement, co-curricular student engagement,
SLCC sponsored student initiatives and activities that meet defined SLCC learning outcomes)
__ Community outreach and partnerships
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Section 2. Initiative Description
Provide a brief description of the initiative and purpose. (limit 300 words)
Describe both the community that will be served by the initiative and the impact of the initiative on the
identified community and the College. (limit 300 words)
Please describe how your initiative advances the program objectives to
If the award is for funds to significantly modify an existing initiative, please explain the specific
innovation and how it will increase the community engagement component of the existing program.
(limit 300 words)
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Explain the merit of your project. If it is a new project, how does it contribute to economic and
community development, champion diversity and cultural enrichment in the college and community, or
provide community service and involvement opportunities? If the proposal represents a significant
modification to an existing initiative, please make note of the specific innovation and how it will increase
the community engagement component of the existing program. (limit 300 words)
Section 3. Contributions of and Participation by Students, Faculty, Staff, and/or Partners
Please include the projected level of involvement by students, faculty, staff, and/or partners, including
description of number of student, faculty and community participating and their roles. (limit 250 words)
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Section 4. Time Line
Please indicate when the initiative’s activities will take place and when they will end. Please note, all
projects must be completed in the time identified in this section and before the end of the fiscal year.
____/____/____ - ____/____/____
Section 5. Evaluation and Dissemination Plan
How will the initiative’s impact be measured and assessed? (limit 250 words)
How and when will the knowledge gained from the proposed initiative be disseminated? Sample activities
include formally presenting to colleagues in a departmental or area meeting on knowledge and skills
gained from the project; facilitating a public discussion, brown bag or workshop; or presenting a paper or
conducting a workshop at a conference. (limit 250 words)
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Section 6. Budget and Budget Justification
Index Number: _______________________________
Account Code: 70000
Contact Info: _______________________________
Expense Budget (may submit on separate paper)
Detailed Description
Cost
Total Projected Expense
If the rational for a cost is not included in previous answers, you may use the space provided to briefly
explain need. For example, transportation costs will fund student travel and to and from a museum.
Section 7. Letter of Commitment from Community Partner
Please include a letter of commitment from the primary community partner verifying that your initiative
represents a mutually beneficial relationship.
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