MINDS MATTER: MINI-GRANT PROPOSAL FORM
Due Date: September 15, 2013
Name of Contact:
Unit/Department:
Email:
Title of Contact:
Phone:
Approximate date of event:
Name of the event:
_____________________________________________________________________________________________
Describe the event (e.g., lecture, film, dance, art exhibit). Please attach a brief biography of each speaker.
How does this event relate to the 2013-2014 Common Experience theme?
What is the intended outcome for this event? (Explain how this event will contribute to a better understanding
of mental health and illness.
Venue:
Anticipated number in attendance:
Who is the anticipated audience for this event?
How will this event be publicized (include any relevant fliers, etc.)?
Who are the cosponsors for this event and what are they contributing?
Name of Cosponsor
________________
________________
________________
Financial Contribution
________________
________________
________________
Required Funding (INCLUDE LINE ITEMS)
1.
2.
Other Non-Financial Contribution
____________________________
____________________________
____________________________
Amount:
3.
Less collaborative funding total from above
TOTAL AMOUNT REQUESTED
Do you agree to use the Common Experience logo on publicity materials and provide information about your
event for the Common Experience website?
Yes:
No:
Do you agree to submit a follow-up report within one month of the event? Yes:
__________________________________
Representative Signature and Date
No:
_________________________________
Representative’s Title
RUBRIC TO BE USED TO SCORE MINI-GRANT PROPOSALS
This form will be filled out by the Review Committee
Name of Contact:
100% of points
Name of the event:
75% of points
The event is
moderately
related to the CE
theme (15)
Anticipated
audience is very
diverse: more
than one college
(15)
50% of points
The event appears
to related to the CE
theme, but proposal
is unclear (10)
Anticipated
audience is
moderately diverse:
more than one
department (10)
25% of points
0% of points
The event is only
minimally related
to CE theme (5)
The event does
not relate to the
CE theme (0)
Anticipated
audience is
slightly diverse:
multiple class
sections (5)
Anticipated
audience is not
diverse at all: one
section of a class
(0)
There is
significant
financial support
but very few
cosponsors (15)
There are multiple
cosponsors but
financial
contributions are
limited (10)
There are very
few cosponsors
and very limited
financial
contributions (5)
There are no
cosponsors for
the event and no
financial
contributions (0)
Active
Participation
(20 points)
The event allows
for high active
participation in
hands-on
activities (20)
The event allows
for moderate
participation in a
hands-on activity
(15)
The event allows for
audience
participation
through active
discussion (10)
The event will
allows for
minimal
participation via
questions and
answers (5)
The event is
passive in nature
and does not
allow for
audience
participation (0)
Potential for
Continued
Dialogue
(12 points)
The event has
clear potential for
continued
dialogue related
to the Common
Experience theme
(12)
The event has
moderate
potential for
continued
dialogue related
to the Common
Experience theme
(9)
The event appears
to have potential for
continued dialogue,
but the proposal is
not clearly written
(6)
The event has
limited potential
for continued
dialogue related
to the Common
Experience theme
(3)
The event has no
potential for
continued
dialogue related
to the Common
Experience theme
(0)
Publicity
(8 points)
There is an
excellent plan for
how this event
will be publicized
(8)
There is a good
plan for how this
event will be
publicized (6)
There is an
acceptable plan for
publicity (4)
The plan for how
the event will be
publicized is
unclear (2)
There is no plan
for how the event
will be publicized
(0)
Relation to
CE theme
(20 points)
Diversity of
Audience
(20 points)
Cosponsors
(20 points)
The event is
highly related to
the CE theme (20)
Anticipated
audience is highly
diverse: faculty,
staff, students,
community (20)
There are
multiple
cosponsors that
are providing
significant
financial
contributions (20)
TOTAL
TOTAL POINTS: ________________________
Follow-Up Report
To be submitted within one month of the event
Name of the event:
Date of event:
Venue:
Cost of event:
Cosponsors:
Number in attendance:
_________________________________________________________________________________________
Summary of Event:
Explain the degree to which you were able to meet your expected outcomes:
Completed by:
Date: