Before completing this form, please read the instructions and evaluation criteria document. The application deadline is October 1, 2020.
Project Lead Information

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* 1. Name:

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* 2. Email:

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* 3. Phone Number:

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* 4. Institutional Affiliation (if applicable):

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* 5. Are you a CUGH member? You can see a list of our institutional members at www.cugh.org.

Please indicate the name and contact information for the institution (or individual) who will receive and administer this award.

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* 6. Name:

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* 7. Email:

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* 8. Position:

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* 9. Institution:

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* 10. Please attach the project description-- maximum of 2 pages.
**Please reference the criteria **
Proposal Template:
1) Project Title
2) Project Duration
3) Primary Target Audience: Context (200 words maximum)
4) Goal (200 words maximum)
5) Objectives and Timeline: Project Methodology (200 words maximum)
6) Disseminating Project Results and Promoting Project Sustainability. 

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* 11. Requested funding-- please attach a detailed budget and budget justification.

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* 12. Please tick all that apply:

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