Diversity Initiatives Request Form

Section I - Demonstrating Initiative Grants

Applicant Information

Name
Department
Email Address
Campus Address (include zip)
Office Phone

Section II : Project Information

Name of the Demonstrating Initiative Project

Has this initiative previously been funded by the DI Grant Program?

Yes

No

Since this has been funded previously, what was the grant number?
(i.e. 860736-XX)

A brief summary or abstraction of the project:

Please provide a brief description of the demonstrating initiative project you want to launch and how it ties with SBU Strategic Initiative Our Moment (max 5000 characters)

Detailed description of the Demonstrating Initiative Project

Please attach a PDF document that provides a detailed description including:

Objectives and goals
Target audiences
Activities and timeline
Expected outcomes/impacts
Evaluation Plan
Detailed Budget breakdown

or drag here

Budget and Funding

What is the total project budget?
What is the amount requested from the Demonstrating Initiative Grant?

Is there any other source of funding?

Yes

No

Please list the other funding source(s)

Section III - Signature

Project Coordinator's Signature

By signing below, I affirm that all the information is true and correct. I understand that an incomplete or incorrect application will be rejected.
I understand that I must abide by the Stony Brook Procurement policies for expenses.

Type your name below to generate a signature.

Please provide the Chairperson or Dean's email address below - For any Demonstrating Initiative request above the amount of $10,000, you will need departmental approval.