Staff Retiree Development Grant Application

A FINAL REPORT must be submitted to the Human Resources within 1 month of the end of the grant period.

Maximum Award is $1,500.

Failure to submit a final report will result in disqualification from future grant opportunities.

All materials and/or equipment purchased with the aid of grant funding become the property of Skidmore College when the funded project is completed.

Fields marked with an asterisk (*) are required.

Name * :*

Email Address (you@skidmore.edu) * :*

Mailing Address * :*

Department of record at Retirement * :*

Date of Retirement:

Grant Period * :*

Funds Requested * :*

Title of Project * :*

Description of Project * :*

Provide a statement of 750 words or less describing the project in language understandable to the non-specialist. Please explain how the project would promote continuing education, benefit the College or local community, and/or model creative approaches to life in retirement.

Projects involving research with human subjects or human tissues, or vertebrate animals, may require review by the Institutional Review Board (IRB) or Institutional Animal Care and Use Committee (IACUC). The staff retire grant review panel will advise applicants whenthis procedure is relevant.

If your application is for the benefit of a non-profit organization, please add this additional information:

Name of the organization:

Address of the organization:

Mission of the organization:

Website of the organization:

Does the organization have an official 501(3)(c) designation?

Yes

What is your role or affiliation with the organization?

What is your involvement in the project?

Proposed Budget Information

Itemized Supplies Budget:

Itemized Fees and Contracted Services Budget:

Itemized Travel Budget:

Itemized Equipment Budget:

Other Itemized Costs (be specific):

Estimated Total Budget * :*

PLEASE NOTE: Original, itemized receipts for all items must be attached to expense reports. Your credit card bill and the receipt showing the total amount paid for restaurant charges are not considered adequate proof of purchase.

If the committee is unable to fille the total amount of your grant request, will you be able to supplement the funding or modify the project to accomplish some of the goals of the project? A yes/no answer is sufficient, or you may feel free to elaborate.

Elaborate here * :*

Please provide information regarding source(s) and amount(s) of funding for this project from sources outside Skidmore.

Other Sources of Funding:

By entering your name here, the staff retiree grant review panel will accept this as a fully-signed document.

Signature * :*

Date (MM/DD/YYYY) * :*

Staff Retiree Development Grant Application

Retirees Contact

Faculty Issues:

Retiree Committee and Website Submissions:

MAIL