Application Form
PROJECT HIGHLIGHTS:
Please provide a title and brief description of your project:
Title:
Description (no more than 75 words):
Project Start Date: / Project Completion Date:
Grant Amount Requested:
Office of Sustainability Use Only
Date Received: ☐ Approved: ☐ Not Approved:
Director, Office of Sustainability (signature) / Date
Green Grant:
Alberta Emerald Foundation Grant:
TOTAL Amount Awarded:
APPLICANT INFORMATION:
Name: / Student Club, Department or Central Unit:
Email:
Phone: / Mailing Address:
Affiliation: ☐ Undergraduate Student☐ Graduate Student☐AASUA Staff☐NASA Staff
FINANCIAL INFORMATION:
Note: Student organizations must be registered with the Student Group Services at the Students’ Union. Financial transfers may take 30 days to process.
Mailing Address
SPONSOR INFORMATION:
Note: Student applicants who are not part of a registered student organization must have a faculty sponsor partnering on the project to whom the funds will be transferred.
*Sponsor’s Name: / Faculty/Department:
Sponsor’s Title: / Sponsor’s Email:
Sponsor’s Telephone: / Sponsor’s Speed Code:
*Note to Faculty Member: By signing as a sponsor, you acknowledge that the information provided in this application, including the proposed budget, does not duplicate other sources of funding made available for this project.
Sponsor’s signature / Date
INSTRUCTIONS:
IMPORTANT INSTRUCTIONSOnly one electronic copy of this application form is required. Please email your completed electronic application (PDF or MS Word document) with “Green Grant Application” and the title of your project in the subject line to:
Please keep an original copy of your submission (with all required signatures) on file. You will be required to supply the original signature page if your application is accepted. Incomplete applications will be returned. Attachments (if critical to the submission) must be appended to the end of the electronic application.
Note: The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. It will be used for the purpose of adjudication and administration of the Green Grant program and related programs delivered by the Office of Sustainability. Direct any questions about this collection to the Director, Office of Sustainability, 2-06 North Power Plant, Edmonton, AB T6G 2N1; Tel 780.492.9289; Fax 780.492.8453
APPLICATIONIn what areas will your project advance sustainability at the University of Alberta?
My project will help campus make progress on sustainability by (click one or more as applicable):
☐ Integrating sustainability into teaching and learning.
☐ Integrating sustainability into facilities, operations and services.
☐ Integrating sustainability into campus, community outreach and university life.
Please explain:
How is your project linked to the sustainability goals of the University of Alberta? (300 words or less)
How does your project advance UAlberta’s sustainability goals as outlined in one or more of the following documents:
1) the University of Alberta’s Institutional Strategic Plan;
2) the University of Alberta’s Sustainability Plan;
3) A Plan for Deepening Sustainability Education and Scholarship at the University of Alberta 2016-2020 – companion document to the 2016-2020 Sustainability Plan;
4) Sustainability Tracking, Assessment & Rating System.
Outcomes. What improvements to sustainability will occur as a result of your project? (300 words or less)
Who is the target audience for your project? As a result of your project, what knowledge, values, skills, attitudes, behaviours or sustainable practices will change in your audience?
Outputs & Activities. What specific outputs or activities will your project produce? (300 words or less)
Evaluation. How will you know if you have achieved the changes you planned for? (300 words or less)
How will you know if you have achieved your outcome(s)?
How will measure success of your outputs and activities?
Expenses. How much will your project cost? (add rows if required)
Description of Activity/Item and related expense / Cost ($)
Total:
Revenue. Please describe your sources of revenue for this project (e.g., club funds, sponsorships, etc.).
Name of organization and their funding contribution / Funding Contribution ($)
Total:
OTHER INFORMATION:
How did you hear about Green Grants?
☐ Friend/Colleague ☐ Poster ☐ Advertisement ☐ Website ☐ Our Newsletter
☐ Our Blog [suh-steyn] ☐ Twitter ☐ Facebook ☐ Student Guidebook
☐ Other, please specify:______
Are you a current/past participant in the ecoREPs/Leading Sustainability At Work program?
Yes No
Are you a current/past campus sustainability volunteer with Sustain SU or the Office of Sustainability?
Yes No
Are you involved in the Green Labs program with the Office of Sustainability?
Yes No
Is this project lead by a youth under the age of 25 years?
Note: Youth-lead projects may be eligible for matching funds from the Alberta Emerald Foundation.
Yes No
ACKNOWLEDGEMENTS:
If your application is successful, you agree to (please indicate your agreement by checking each of the following items):
☐ Provide the Office of Sustainability with brief financial report that verifies funds were expended solely for this project. You will contact the Office of Sustainability for approval if there are any changes to the project before they occur. Any unspent funds associated with this application will be returned to the Office of Sustainability.
☐ Provide the Office of Sustainability with a final report containing: testimonials from program participants/organizers, details about the events/tool, number of participants, what was learned, and any associated evaluation results outlined in your proposal. The report will include up to 3 pictures capturing your event. Photo releases must be provided with all pictures giving the Office of Sustainability permission to use them in print and online media in perpetuity.
☐ Provide the Office of Sustainability with a brief story (approx. 300 words) including at least one quote from a participant or organizer for use in print and online publications. This story may be edited by the Office.
☐ Acknowledge the Green Grant awarded at the event, in presentations, publications, reports or outreach associated with your project, with the following statement: “Supported (in part) by the Office of Sustainability’s Green Grant Program at the University of Alberta.”
☐ Pursue Green Spaces Certification for your event;
SIGNATURE:
Green Grant Applicant (print name)Signature / DateGreen Grant Application / Page 1 of 6
sustainability.ualberta.ca