Course Innovation Grant Application
OFFICE USE ONLY
Amount Funded:
Date Approved:
File Number:
Department Number:
To apply, please complete the following form. Obtain signatures, attached supporting documentation
and mail or deliver to the Office of Research and Sponsored Programs – Room 208 Old Main no later
than 12 noon on Friday, April 1, 2016. Proposals that are incomplete or do not follow stated guidelines
will not be reviewed.
Course Innovation Title:
Primary Author:
UWSP ID #:
Email address:
Department of Office:
College or Adm. Area:
BRIEF DESCRIPTION OF PROPOSAL: (limit to text box area)
Check ALL categories that apply to this proposal: (must be at least 0.50 FTE)
☐ Faculty
☐ Academic Staff
IRB/IACUC/WEPA Approval:
☐ Not Required
☐ Will Submit
Credit received for course:
☐1
☐ Submitted ☐ Approval Received
☐2
☐3
☐4
☐5
☐6
Signatures:
___________________________________
Applicant
_____________________________
Date
I have received a copy of this proposal and anticipate no problems of a fiscal or personnel
nature should this proposal be funded. Based on the number of eligible faculty, our
dept./disciplinary unit is submitting ☐ 1 ☐ 2 ☐ 3 grant applications. (See guideline for limits)
___________________________________
Dept. Chair or Director
______________________________
Date
1
Course Innovation Co-Authors (please duplicate page as necessary)
Co-Author:
UWSP ID #:
Email address:
Department of Office:
College or Adm. Area:
Signature:
Co-Author:
UWSP ID #:
Email address:
Department of Office:
College or Adm. Area:
Signature:
Co-Author:
UWSP ID #:
Email address:
Department of Office:
College or Adm. Area:
Signature:
Co-Author:
UWSP ID #:
Email address:
Department of Office:
College or Adm. Area:
Signature:
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NARRATIVE
The Narrative, excluding Supporting Documents, is limited to 5 pages. Page size 8-1/2 X 11;
margins 1 inch on each side; font must be in Arial, Times New Roman, or Calibri type size 11
point; single-spaced. Please review Course Innovation guidelines for required information.
PROJECT SYNOPSIS:
Please insert project synopsis here based on CI guidelines.
RATIONALE:
Please list rationale here based on CI guidelines.
COURSE DESCRIPTION:
Please insert course description here based on CI guidelines.
OBJECTIVES:
Please insert learning objectives and outcomes here based on CI guidelines.
PROJECT EVALUATION & DISSEMINATION:
Please insert evaluation & dissemination plans here based on CI guidelines.
LITERATURE CITED:
List all literature cited in the above portions of the proposal in alphabetical order.
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VITA Summary (limit – two pages)
Name:
Department:
Rank or Title:
Date Hired:
Highest Academic
Degree:
Date Awarded:
BRIEF RESUME
Please insert response here and delete the instructions in this box from the final version of your application.
Please focus on professional experience which will give evidence to the reader of your ability to
undertake the intended project. List related publications, exhibits, and performances in the
past five years. (Please, do not send a complete resume. Focus only on details pertinent to this
project.)
LIST PREVIOUSLY AWARDED GRANTS OF ANY TYPE (external or internal) IN THE
PAST FIVE YEARS.
Please insert response here and delete the instructions in this box from the final version of your application.
For past UPDC grants, state the title of the grant, date it was awarded, and summary of results
(see General Guidelines).
SUPPORTING DOCUMENTS:
Letter of Support – Applicants are required to include a letter of support from their respective
Department Chair, Discipline Coordinator, or in the case where the applicant is the Dept. Chair
or Discipline Coordinator, a letter of support from the College Dean is required.
Additionally, the applicant must provide copies of correspondence from the college Information
Technology support person and the information security person in regards to software,
technology, or other needed additional support related to the proposal.
Final Report:
A report detailing the accomplishment of the objective(s) shall be submitted to the Office of
Research and Sponsored Programs no later than 90 days after the project period end date.
UPDC awardees who do not submit the required final report are ineligible for future awards
until the report has been submitted.
The final report alone does not satisfy project evaluation and dissemination requirements as
stipulated in part 7 on the Narrative instructions.
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UPDC Course Innovation Summer Stipend & Required Match
Name of Applicant:
Project Title:
Project Period:
Dates of previous UPDC
salary award(s) (if any):
UPDC/CI Summer Stipend:
$1,500.00
OTHER SOURCES AND AMOUNTS OF SALARY ANTICIPATED DURING THE AWARD PERIOD:
Please provide response in this area and remove instructions in your final version.
NOTE: REQUIRED DEPARTMENT MATCH ($150)
_________________________________________________________________
Signature
I have reviewed this proposal and am willing to provide $150 match.
Department (account) number:
______________________________
Dept. Chair or Director
_________________________
Date
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GRANT APPLICATION CHECK-OFF SHEET
The grant application should include the following sections in order. This form is provided to
insure completeness of the grant application. DO NOT INCLUDE IT WITH THE APPLICATION AT
THE TIME OF SUBMISSION.
☐ Cover sheet completed and signed by the applicant(s) and Department Chair(s).
☐ Proposal narrative completed according to guidelines.
☐ Project Synopsis
☐ Rationale
☐ Course Description
☐ Learning Objectives/Outcomes
☐ Project Evaluation & Dissemination
☐ Literature Cited
☐ VITA summary completed including a list of previous grants received. (limit 2 pages)
☐ Summer salary and match approval completed.
☐ Letters of Support from Dept. Chair/Discipline Coordinator or Dean if required.
*OTHER (limited to 5 pages)
☐ IRB approval: Prior to beginning any research involving human subjects at UWSP, or any
other location, you must be approved or certified by the University’s Institutional Review Board
(IRB) for the Protection of Human Subjects. This includes any human subject research at other
locations, if being funded by UPDC. See Appendix A in the Guidelines for details.
☐ IACUC approval: Prior to beginning any research involving animal experimentation at UWSP,
or any other location, you must be approved or certified by the University’s Institutional Animal
Care and Use Committee (IACUC). This includes any animal experimentation research at other
locations, if being funded by UPDC. See Appendix A in the Guidelines for details.
☐ If required, certification for environmental impact (WEPA). See Appendix A in the Guidelines
for details.
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