GEF Project Information Checklist and Cover Sheet

GEF Project Information Checklist and Cover Sheet

This fully completed form (includingall signatures)mustaccompany each copy oftheapplication.

SUBMISSION INSTRUCTIONS

A completed application consists of three documents:

(1) Project Information Cover Sheet

(2) Project Narrative

(3) Budget Form

Completed documents should be submitted via email to the Global Engagement account at . The nameofthedocumentsmustbegin with thelast nameofthe proposed principal investigator. The final complete application must be received by 5:00 pm EST on April 2, 2018.

Please ensure that all items listed on the checklist are completed and submitted with your application. Failure to provide all materials at the time of submission will delay the review process and may jeopardize the applicant’s chance of receiving funds.

PROJECT INFORMATION

Project Title:
Award Type (Research and Engagement OR Convening):
Total Project Budget:
Period of Performance:
Region/Country of Focus:
PrincipalInvestigator:
Co-PrincipalInvestigator(s):
Primary Point of Contact:
EmailAddress: / PhoneNumber:
Title:
UniversityDepartment/School:
CampusAddress:
Senior BusinessAdministrator:
BA Email: / BA Phone:

PREVIOUS APPLICATIONS

Have you submitted a proposal (including a statement of interest) to the Global Engagement Fund, Penn China Research and Engagement Fund, or Penn India Research and Engagement Fund in previous years?

Yes No

If yes, please provide the title of the project, period of performance, project amount, and brief description of the project.

ABSTRACT

The abstract is limited to 100 – 200 words and should be written for a general audience. Please note that abstracts will be posted to Penn Global’s website (

COLLABORATIONS

Please list all partners (academic/corporate/governmental) with whom you will work on the proposed project. Briefly indicate the nature of your collaboration, i.e., research, training, course development, etc. In addition, CVs and bios for all key personnel and partners should be included as an attachment to the narrative.

Partners at Penn

Please list all of the partners with whom you will work that are located at Penn, and indicate the nature of your collaboration.

In-Country Partners

Please list all of the in-country partners with whom you will work, and indicate the nature of your collaboration.

Other Partners.

Please list all other partners with whom you will work, and indicate the nature of your collaboration

TIMELINE

Please provide a timeline of activities, outlining key activities and deliverables. Funding under this program is limited to one year, with exceptions made on a case-by-case basis. Applicants may attach additional pages, if necessary.

CONFLICT OF INTEREST STATEMENT

Do any oftheInvestigatorsor other personnel responsible for thedesign,conduct, or reporting oftheproposed research, or their spousesor dependent children, haveany SignificantFinancial Interestas defined intheFinancial Disclosure Policy for Sponsored Projects thatwouldreasonably appear to be affected by theactivities to be funded, thuscreatinga potential conflict ofinterest?

Yes _____ No _____

SIGNATURES*

Primary Principal Investigator Signature:
Printed Name: / Date:
Department Chair Signature:
Printed Name: / Date:
School Dean Signature:
Printed Name: / Date:

* Electronic signatures will be accepted as “s/ full name of signatory.” If you choose this option, you MUST include an attached email from the signatory stating that they have consented to the signature for your GEF application.