2. Department(s):

3. Home Address:

4. Home Telephone Number:

5. Department Extension:

6. E-Mail Address:

7. Project Title:
(Project Starting Date)

8. Project Classification:

9. Show how your project contributes toward one or more of the college goals as listed at http://www.lagcc.cuny.edu/strplanning/plan.asp. Please refer directly to the strategic plan and clearly list the college goals as they relate to your project (applications without this information will be returned for completion).

10. Amount requested (please attach supporting document to Budget):

11. Requested funds from other sources – (amount and source) – dates:

12. List all previous Professional Development grant year(s), grant amount(s) received, and project classification. Applications without this information will be returned.

13. Starting date and semester:

14. One hundred and fifty (150) word abstract, double spaced, not to exceed 2 pages.

In the space below, provide a description of your project. The abstract should (a) state the purpose of the project, (b) identify the subject area of primary focus, and (c) outline the project’s major activities. If more than one person prepared the application, please list each applicant’s name.

15. Evaluation

How will you determine if your project was successful? Be specific and identify measurable, concrete criteria.

16. Budget

Provide a complete budget and specify the items for which Professional Development Grant funds will be used. List and describe all budget items requested; attach a price list when appropriate. Indicate specifically how each item relates to your purposes and activities. Professional Development Grant funds can not be used to purchase clothing or equipment, to pay for instruction or tutoring, or to provide food. In addition, grant funds cannot be used for services generally available at the college such as mailing or photocopying, nor can funds be used for program/services mandated by the college or the university. Be specific. Please list other funding sources to which you have applied or plan to apply (page 5 bottom has space available for this information).