Alex Trebek Innovation and Challenge Fund

Application Form for Professors and Community Partners *

CONTACT INFORMATION
SURNAME: / GIVEN NAME(S):
ADDRESS: / CITY/PROVINCE: / POSTAL CODE:
AREA CODE AND PHONE NUMBER`: / EMAIL ADDRESS:
PLEASE CIRCLE THE CATEGORY THAT BEST DESCRIBES YOU:
  1. I am a professor.
Employee number:
  1. I am a Community Partner.
Name of the organization:
PROFESSORS: Indicate your faculty appointment, please specify the department. Also, indicate if you have a valid FOAP to receive these funds.
COMMUNITY PARTNERS/PROFESSORS: Indicate who will be the supervisor of the uOttawa students.
COMMUNITY PARTNERS/ PROFESSORS: Indicate if the volunteer placement (s) are or will be included on the Community Engagement Navigator. Y /N

*If you are a students, you must apply on the Financial Aid website.

  1. Please provide the name of the community engagement project, its location, and indicate its start date and end date.
  1. Please list the project objectives and key activities. Please give background information (context) on the project by explaining what the community need is and how the project responds to it. Please indicate why you think the project or approach is innovative. What indicators will you use to determine whether your project is successful and has reached the set objectives? Please indicate the number of uOttawa students who will participate in the project as volunteers and, briefly describe their role.
  1. Please explain how the Community Partner or receiving community will be involved in the project design and implementation.
  1. Please list the expected outcomes for both the end of the project and the medium-term. Specify the number of individuals who will benefit directly and indirectly from the results of the project. (The direct beneficiary is the person who receives the services. There may also be indirect beneficiaries, such as family members who benefit from an increase in revenue when the direct beneficiary obtains a better job as a result of the support services he or she has received.)
  1. Please outline the total project budget. Indicate the amount that you are seeking from the Fund. Note: Funding is not intended to cover the recurring operating costs of the organization, such as salaries. If the organization wishes to include them in the budget, it must demonstrate in its application how it will manage to cover these costs at the end of the project.
  1. If you are a professor, please clarify your role in the project planning and implementation.

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Alex Trebek Innovation and Challenge Fund application Rev.July 28, 2015