GASGC

Non-Affiliates Proposal Application

Last name * :
First name * :
Address :
City :
State :
Zip :
Email address * :
Phone number * :
Fax number :
Title of proposal or funding request:
Category : Pre-College/Informal Education Higher Education Research General Public
Abstract (150 word maximum) :

Start date :
Ending date :
Amount of funding requested :
Date funding required :
Check payable to :
Relevance to the National Aeronautics and Space Administration (NASA) :

Timeline (give start date, end date and details on milestones) :

Personnel (list all individuals working on the project and a brief description of their duties) :

Budget and/or resources needed (include details of cost and list any funding from other sources) :

Additional Required Information :
Numbers of students graduate * :
Numbers of students undergraduate * :
Numbers of K-12 * :
What are the grade levels ? (K-12 only) * :
Number of teacher participants ? * :
Number of parents involved in project (K-12 only) * :
Number of administrators involved in project *:
Number of others involved in project * :
Will this program be evaluated or involve tracking. If so, please explain * :

Please confirm by signing below - • The Georgia Space Grant Consortium will be included in all publicity as a sponsor or co-sponsor of your program. • A complete accounting of expenditures will be given to the GSGC For a copy of the GSGC official logo, email gsgc@gatech.edu .
Initials * : Date * :
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