Grant Application - Green Chemistry & Engineering Internship Grant State Fiscal Year 2018

/ GrantApplication
Green Chemistry Engineering Internship Grant
State Fiscal Year 2018
Doc Type: Grant Application
MPCA Use Only
Grant ID#:
Grant/project administrator:

Please read the complete Request for Grant Applications (RFGA) and other associated documents before submitting this application.

Instructions:

Addressmust be a facility located in Minnesota, which will host the intern.
Mailing address, if applicable, may be different than host site in Minnesota.
Contact name seeks the company employee with most day-to-day supervision of the intern; most likely the mentor. If a different employee’s information is provided here in Part 1, please provide the mentor’s name and contact information in Part 3a.
Submit application (in Microsoft Word and Excel, respectively) with the subject line,“Green Chemistry & EngineeringInternship 2018”.

Part 1Application cover page

Applicant name:
Address:
City: / State: / Zip code: / County:
Mailing address (if different):
City: / State: / Zip code: / Country:
Contact name: / Title:
Email: / Applicant’s website:
Phone:
Project title:
Briefproject intro summary:
A briefdescription of the proposed project (proposing what, why, and expected results). Field restricted to maximum five lines of text.
Grant requested: / $ / Match/In-kind $ contribution: / $ / Total project cost: / $
($10,000 max) / (Optional)

Background

1. / Applicant is governed by a Board? Yes No
If yes, does this submittal include necessary board resolution(s)? Yes No
Authorizing board resolution(s): A resolution authorizing the applicant to enter into and sign the grant agreement is required from any organization in which a board of directors makes decisions. Such documentation should be submitted as part of the application; a template is available on the last page of this application form. You may submit an unsigned resolution as a placeholder. If the signed authorizing resolution is not being submitted at the same time as the application, please indicate why and when such documentation will be provided. Not providing the necessary documentation or being able to submit it in a timely manner will have a negative impact on the evaluation of the application.
2. / Has applicant ever received Minnesota Pollution Control Agency (MPCA) grant funding before? Yes No
3. / Applicant is in compliance with Minnesota’s tax and environmental regulatory requirements? Yes No
If no, explain (field is restricted to maximum four lines of text):

Part 2Intern project description

Provide a complete response that addresses the following items, at a minimum. To ensure a comprehensive project description, use as much space as needed for questions under Parts 2, 3, and 4.

2a. / Job Description: Please provide a description of the intern position and how it will advance the development or path to market of product(s) improved through use of green chemistry or engineering principles. Describe the product type(s) involved. Provide a scope of work involving activities within research and development, manufacturing, purchasing, sales or other company functions.Describe the mentor’s position at the facility and how the mentor will help support the intern. Include as well, the intern’s desired skill set and salary range, depending on education and/or experience, and how the salary range is fair and competitive given employment conditions local to the host facility.
2b. / 1. / Provide goals, anticipated outcomes, milestone(s), intended hazard reduction (identifying if the project helps to reduce one or more chemicals from the Minnesota Department of Health’s(MDH) Priority Chemicals list[found on MDH Toxic Free Kids Act website at ] or MDH’s Chemicals of High Concern list[found on MDH Toxic Free Kids Act website at ]), valueto the company (such as cost reductions, revenues, new markets), other description of the intern project:
2. / Likelihood of achieving projected outcomes/benefits:
2c. / Intern attributes desired:
Address questions such as: Do interns need to be current students? If recent graduates are eligible, how recent? What degree programs are eligible? Do you prefer local interns, or are interns who are willing to relocate acceptable?
2d. / Learning objectives anticipated for the intern:
Thinking about the functions you expect the intern to interact with (research and development, design and engineering, manufacturing, purchasing, sales or other), and the product(s) or component(s) involved, describe what you expect the intern can learn in the course of their internship.
2e. / Timing:
Address questions such as: What is your start date? What is your end date? Would you prefer candidates who could continue working after the internship? How much flexibility can you offer?
2f. / Hiring process:
Address questions such as: Do you need to interview more than one candidate? If so, how many? Does the position need to be posted on your website? If so, for how long? Will candidates need to fill out an internal application before being interviewed?Can you cover travel costs for relocation? If not, can a stipend be advanced to fund travel?
2g. / Assets and resources available to the applicant to implement the project:
Clearly explain applicant’s financial strength and stability (assets and resources) for this project.
2h. / Additional information–Optional

Part 3Experience and qualifications

3a. / Applicant’s (company’s and mentor’s) experience and qualifications related to the practice of green chemistry and/or engineering:
Describe (and attach additional information, if desired) the experience and qualifications of both the eligible company and the individuals key to the intern project (e.g., supervisor, mentor), and demonstrate their ability to effectively mentor an intern to achieve agreed-upon goals and objectives. Provide the mentor’s contact information here if it was not provided in Part 1.
3b. / If applicable, describe any significant participants’/partners’ experience and qualifications related to green chemistry and/or engineering:
Significant participants/partners are those who are key to the success of the internshipand/or provide funding or other significant resources (technical services, space, equipment, supplies, etc.). Provide contact information for each partner.

Part 4Project Workplan and Budget

4a. / Project workplan:
1. / Goal statement(s):
Identify the purpose(s) and expected outcomes of the project – why is this project necessary and what it is that you hope to achieve. Suggestion – refer to your responses in Part 2b.
2. / Objectives/tasks for each Goal statement:
Use the following format for your project workplan. If awarded a grant, this workplan and budget will be incorporated into your grant agreement andfinal project and budget reporting for your project will follow this same format.
Objectives/Tasks – Outline the key steps (Objectives) to implement the project and the necessary actions (tasks) to implement each step. There is no minimum or maximum number of objectives/tasks a project must have, but the two “must have” tasks for every project are Final Workplan Submittal (as agreed to between company and intern; the first task), and Final Report and Budget Submittal (the final task). For each Task, identify the timeframe, responsible party, and estimated funds.

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Blank Example of format to use for Objectives/Tasks:

Objective __ of __ -- ______

Task __: ______

Timeframe: ______

Title of Person(s) Responsible: ______

Estimated Funds:Grant: $______OPTIONAL Match: $______Total: $______

Task __: ______

Timeframe: ______

Title of Person(s) Responsible: ______

Estimated Funds:Grant: $______OPTIONAL Match: $______Total: $______

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4b. / Budget is attached, using the template? Yes No
If no, explain:
TheBudget template form can be found through the MPCA Green and Safer ProductChemistry Grants webpage at and should be submitted in Microsoft Excel format.

Complete the Budget template form,being sure to include each Objective and related Tasks identified in your project workplan.Refer to the RFGA for detail on eligible and ineligible expenses. Be sure to indicate if your project proposal is requesting equipment or other costs listed in the RFGA as ineligible except as approved by the MPCA on a case-by-case basis.

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Please use the following format and specific language for your Authorizing Resolution:

Minnesota Pollution Control Agency

Green Chemistry & Engineering Internship Grant

State Fiscal Year2018

Authorization Resolution

WHEREAS, / (name of your organization) has applied for a
Green Chemistry & Engineering Internship Grant from the Minnesota Pollution Control Agency (MPCA)
WHEREAS, if MPCA funding is received,
(name of your organization) is committed to implementing the proposed project as described in the grant application; and
WHEREAS, MPCA requires that / (name of your organization)
enter into a grant agreement with the MPCA that identifies the terms and conditions of the funding award;
BE IT RESOLVED THAT the / (name of governing body)
hereby agrees to enter into and sign a grant agreement with the MPCA to carry out the project specified therein and to comply
with all of the terms, conditions,and matching provisions of the grant agreement and authorizes and directs
(name of a position) to sign the grant agreement on its behalf.
(Print name of signing officer) / (Title)
(Signature of an officer with your governing body) / (Date your governing body agreed to this resolution)

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