Application Form
COLABORATION PROYECTS BETWEN THE GOVERNMENT OF ZAPOPAN
AND THE MASSACHUSETTS INSTITUTE OF TECHNOLOGY (MIT)
1. Project
Project Name
2. Applicant Information (Mexican Resercher/Entrepreneurs)
Name(s)
Last Name(s)
Address
University/Company
Department/Field
Telephone
Cell phone
E-mail
3. Applicant Information (Mexican Resercher/Entrepreneurs)
Name(s)
Last Name(s)
Address
University/Company
Department/Field
Telephone
Cell phone
E-mail
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4. Information of the international collaborator (in case the researcher of MIT has been identified for
the collaboration project)
Name(s)
Last Name(s)
Department/Field/Laboratory/
Investigation center
Telephone
Cell phone
MIT E-mail
5. Brief Abstract (limited to 250 words)
Provide a brief summary of the proposed project written for an audience of non-experts. This summary may
be used in promotional materials.
6. Description of collaboration (5 pages maximum)
Project plan that demonstrates the participation of the project leaders and the added value that it would have
if an MIT researcher participated in the project, give relevant information, establish objectives, and the impact
for the municipality. Also, include the work that will be fulfilled, a timeline and other relevant information.
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7.
Description of the proposed project and/or research (limited to 3 pages)
If you would like to include figures or images, please send them as a separate PDF attachment when
you send your proposal.
8. Exchange and activities planned
Describe in detail the exchanges and activities planned (seminaries, workshops, etc)
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9. Budget
Travel (Budget in USD)
MIT team member(s)
Approximate travel
dates and length
Activities planned and
location
Funds requested
$
$
$
$
$
$
Total amount requested for travel abroad: $
Mexican team
member(s)
Approximate travel
dates and length
activities planned and
location
Funds requested
$
$
$
$
$
$
Total amount requested for travel: $
Other spending
Planned activities
Approximate activity
dates
Required funds
$
$
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$
$
Total quantity required for other spending: $
TOTAL QUANTITY REQUIERD FOR THE ZAPOPAN-MIT MEXICO FUND: $
10. Other expenses.
Describe additional activities and how they will be funded.
11. Project sustainability
When the grant expires, ¿How will the project continue?
Application delivery time frame: from April 1st until July 15th 2014
For delivery: keep a copy of this application. After that, send the application to these e-mails:
sgonzalezm@zapopan.gob.mx and amoreno@zapopan.gob.mx. You will receive a confirmation by e-mail that
your proposal has been received. If you do not, please contact us through this phone number: 3818-2200 ext.
1100.
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