City College of San Francisco Grant Concept Approval Form (Form B) All individuals interested in pursuing grant funding must complete this form prior to submitting any proposals. This form enables key College and District leaders to be informed of and approve grants and to ensure the feasibility of your project. For more information about the grants application process, please see: https://www.ccsf.edu/NEW/en/employee-services/research-planning-and-grants/grants.html Contact Information Name: Email: Phone: Proposed Project Title: Department/Unit: Potential Funding Source(s) (include name of funder and specific funding program, if relevant): Link(s) to Request for Proposals (RFP)/Program Announcement: Deadline(s): Is this for a continuation (renewal) of an existing grant? No Yes If so, is it a competitive renewal? No Yes Budget Information Projected Project Total: $ Are matching funds required? No Yes If so, what percentage? % Does the funder require a cash match? No Yes What are the sources you intend to use for matching funds? (please list) Allowable Indirect Rate: Duration of Funding: Estimated Start Date Page | 1 Check here if the funder does not allow indirect Estimated End Date CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14 Project Information Please provide a brief overview of the project, explicitly stating the need for this project and the expected student learning outcomes (or administrative unit outcomes). Have you identified the need for this project in your Program Review? No Yes Describe how this project ties in with your Program Review and brings value to your department or unit: Describe how this project integrates with the District’s Mission Statement, Vision, Strategic Plan, and/or other planning documents and brings value to the College/District: At the conclusion of the project, what aspects of the project must be institutionalized (sustained)? Page | 2 CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14 What is the project’s target population/focus area? (please check all that apply) Assessment and Planning Basic Skills Career and Technical Education (please specify industry sector/s) Community Partnerships Facilities/Renovation Graduation/Transfer Instructional Support Services Professional Development Specialized Student Population(s) (please specify) Student Success Student Support Services Technology Other (please specify) Other Departments Please list all other departments participating in this project or that would be affected by this project: Per the Department Chair Council Collective Bargaining Agreement, the Department Chairs for any of the departments listed here will need to sign this form. Key Project Personnel Please list all project personnel below: Name Title/Role in Project Time Commitment (% FTE or hours) Will this project require that you hire new employees? No Yes Not yet sure If so, how many employees will you need to hire? What role(s) will the new employee(s) have in the project? How will you fund these positions? With this grant Other (please specify): Page | 3 CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14 Project Partners Please indicate all project partners below: Non-Profit/Community-Based Organizations (please list): Colleges or Universities (please list): K-12 Institutions (please list): Industry/Business (please list): Other (please specify): Indicate the estimated number of subawards the budget will include: Facilities Will you need space or facilities? No Yes Not yet sure If so, please describe your facilities needs (e.g., Do you need a dedicated office or classroom space for the project? Or will you need access to lab facilities that you do not currently have?): Level of Support Requested from Grants and Resource Development Office Please tell us what support you will need in preparing your proposal: Consultation (planning/application process) Proposal development Proposal editing/proofing Help with constructing your budget Other (please specify): Page | 4 CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14 Signatures and Reviews I certify that this grant/proposal meets the needs of the department, program, or unit as outlined above. For projects that require hiring staff, I will ensure that all documents pertaining to the hiring of that staff member indicate that the period of employment is effective until (1) the termination of the program or project, (2) termination, reduction, or revision of an applicable portion of the contract or project, or (3) a reduction in the program staff is necessary, or for cause, whichever occurs first. You must collect the signatures below in the order that they appear. Applicant Date Dean/Unit Administrator Date Associate Vice Chancellor over relevant area (if applicable) Date Vice Chancellor over relevant area Date Dean of Grants and Resource Development Date Associate Vice Chancellor of Institutional Development or Chancellor1 Date Please type in the names and departments below that will be affected by this project (including your own, if applicable and if you, the applicant, are not a Department Chair) and obtain the signatures of each named Department Chair (add signatures lines as needed). By signing below, each Department Chair is confirming that s/he has reviewed this form: <Add Your Department Chair Name, Department> Date <Add Other Department Chair Name, Department> Date <Add Other Department Chair Name, Department> Date <Add Other Department Chair Name, Department> Date 1 Grants with a budget of more than $60,000 and/or requiring institutionalization will require the signature of the Chancellor. Page | 5 CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14 At least 2 weeks prior to submitting your proposal, you will need to seek approval of your budget from the Business Office. At that time, please submit this form along with the (1) project budget and (2) Business Office Grants Briefing (Form C) for Business Office approval and obtain the signatures below, in the order in which they appear. By signing this form, the following individuals certify that the budget appears sufficient and that the impact on District resources is reasonable: Controller Date Chief Financial Officer Date Page | 6 CCSF Office of Grants & Resource Development, (415) 239-3677 Grant Concept Approval Form – Form B Updated 2/11/14