Evans Public Service Clinics: Agency Proposal Form


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Agency Proposal Form

The Evans Public Service Clinics is intended as a peer and faculty facilitated vehicle to connect the research, organizational change, and capacity building needs of community organizations and public agencies with graduate student degree projects. Each clinic is limited in size to ten students.

If you have more than one project you wish to submit, please complete a separate form for each project.

You will receive an instant e-mail reply confirming that we have successfully received your proposal. If a student is matched with your topic, you will neet to meet with this student and clinic professor in December to develop a letter of agreement.

To review some sample agency proposals, please click here.

(Fields followed by a * are required.)

Organization: *
Your Name: * Title:
Street: *
City: * State: * Zip: *
Phone: * Fax:
E-mail: *
URL:

Project Contact Individual (if different):

Agency Background Information: *
Please provide some background information about your agency.

Fee Statement: *

A. If our topic is selected and a successful match is made, my organization agrees to pay a $1000 fee, half upon signing a letter of agreement with the student in January and half upon successful completion of the project in June.
yes no (If no, proceed to “B.”)

If yes, please indicate how you would like to pay:
invoice me
credit card (We will contact you for your credit card information.)

B. My organization requests financial assistance to help cover the total project cost of $1,000. A limited amount of financial assistance is available through the financial assistance fund for agencies unable to pay part or all of the fee. If our topic is selected, we request financial assistance in the amount of:

C. Please indicate why you are requesting financial assistance:

Financial Assistance Fund:
My organization is eager to support other agencies unable to pay the fee for the Public Service Clinics. Please accept a donation to the financial assistance fund that will go towards helping financially strapped agencies take advantage of the Clinics this year in the amount of:

List Specific Research Question You'd Like Answered: *
One - two sentences.

Additional Project Background: *
Please describe the project. What would you like to find out or have accomplished, what is the desired project outcome?

What are the key steps that you envision the students will do in this project?*

What are some possible research resources?*

Have you submitted a research project to the Public Service Clinics before?
Yes No *

If students are interested in your topic and have more questions, can they contact you directly?
Yes No *

If you have more than one project you wish to submit, please complete a separate form for each additional project.