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The Center for Educational Outreach
1214 S. University, 2nd Fl., Suite A
Ann Arbor, MI 48104
Phone: 734-647-1402
Fax: 734-998-6387
Supporting Student Educational Outreach (SSEO) Grant Program Application
Student Organization Information
Name of Organization
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Mailing Address
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Student Organization Shortcode Number
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Please select your student organization type:
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Voluntary Student Org
Sponsored Student Org
Please provide a brief description of your organization and its purpose.
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Are you aware of and in compliance with the University Policy on Minors (found here: http://spg.umich.edu/policy/601.34)?
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Yes
No
If yes, are you able to provide proof of compliance?
Yes
No
Please provide any additional necessary comments regarding compliance status:
Contact Information
Please provide information for the person you would like to be the main contact for your organization. This is the person we will contact with questions about the application and notify when a decision is made.
First Name
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Last Name
*
Email Address
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Phone Number
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Program Information
Program/Event Name
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Program/Event Date(s)
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Total SSEO Grant Funding Request
*
Please indicate your program type (check all that apply)
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Information & Exposure: Programs that provide educational information and expose the K-12 population to the experiences and possibilities provided by higher education.
Talent Development: Programs that focus on developing academic interests and abilities among students for specific fields or disciplines (i.e. Engineering, Writing, Mathematics, etc.).
Educational Enrichment: Programs that support existing educational pursuits, including tutoring programs, SAT preparation, field experiences, accelerated learning, career exploration, etc.
Leadership Development: Programs that assist students in developing and honing leadership skills that will help them to be successful in post-secondary education.
Please provide a brief summary of the Program/Event for which you need funding, including the purpose of the event and planned activities.
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Please describe the educational outreach component of your program, specifically how it fulfills the type of program you indicated above.
*
Partner Organizations
Please provide brief information for each partner organization or school that you will be working with during your event.
Partner Organization/School 1
Name of partner:
*
Main Contact:
*
Number of youth participants served by this program:
*
Grade level of youth participants:
*
Partner Organization/School 2
Name of partner:
*
Main Contact:
*
Number of youth participants served by this program:
*
Grade level of youth participants:
*
Additional Partners
If you have additional partners, please upload an excel spreadsheet listing your partners and including the following information for each?
Name of partner organization/school
Contact person
Number of youth participants served by this program
Grade level of youth participants
Funding
Please describe how the funding you are seeking would be used.
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Please complete the following information about other UM or community departments/organizations frp, which you have applied for funding for this event/program.
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
1
Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
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Amount Requested:
Amount Received:
3
Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
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5
Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
8
Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
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Organization/Office Name:
Request Still Pending? (Yes or No)
Amount Requested:
Amount Received:
Please attach an itemized budget for your event that includes expenses (highlighting the expenses you are seeking funding for).
The budget must also include any and all funding sources, including pending requests for funds from other UM or community departments/organizations.
By submitting this document, you attest that the information on this application is correct and that if your organization is awarded an SSEO grant, you further agree to the following:
1. To acknowledge the Center for Education Outreach on all publicity materials;
2. To submit a final report within 15 days of program/event completion.
3. To follow all applicable university policies, including the Policy on Minors.
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