Student Services Planning Form FY 2015
NAME OF PROJECT: (PLEASE CHECK
IF THIS PROJECT IS

NEW
Date Submitted:

EXISTING
 REVISED )
KEY STRATEGY/ENABLING OBJECTIVE:
Implementation Schedule/Time Table
GOAL(S) OF PROJECT:
TARGET:
INSTITUTIONAL GOAL-
UNIT PLAN GOAL-
Meets requirements of the Student Success Act 2012 (SB1456): Check mark all that apply.

INITIAL ORIENTATION

INITIAL ASSESSMENT

ABBREVIATED SEP

COUNSELING/ADVISING

COMPREHENSIVE SEP

AT RISK FOLLOW-UP SERVICE

OTHER FOLLOW-UP SERVICE
TASK (STEPS TO ACCOMPLISH GOAL):
COMPLETION DATE
RESPONSIBILITY (IDENTIFY LEAD PARTICIPANTS AND LIST THE CONTACT NAME OF THE PERSON(S) WHO WILL BE
SUBMITTING THE NECESSARY PAPERWORK FOR ALL APPROVED PROJECTS):
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BUDGET: COMPLETE THE ATTACHED “PROJECTED EXPENDITURES”
SPREADSHEET WITH DETAILED LINE ITEMS FOR EACH EXPENSE.
REQUESTED AMOUNT:
PLEASE CHECK THE TERM THAT BEST DESCRIBES YOUR FUNDING REQUEST:
 ONE-TIME-ONLY
 RECURRING*
$____________________
*Recurring means that you received funding for this project in the previous fiscal year
and/or there will be continued need for funds for this project in the next year.
Burn-Rate: The burn-rate is the rate at which you will expend the funds that you are requesting. In
an effort to monitor and improve our efficient use of funds, please indicate your anticipated burn-rate by quarter.
For example, during the first quarter your burn rate may only be 10% due to the smaller summer session, or
maybe it is 60% in the second quarter due to the event date of your project. If we do not receive specific
information back from you, we will anticipate 25% expended each quarter.
Quarter 1
(July-Sept)
Quarter 2
(Oct-Dec)
Quarter 3
(Jan-Mar)
Quarter 4
(Apr-June)
_______ %
______ %
______ %
______ % = 100%
TECHNOLOGY NEEDS DESCRIPTION (INCLUDE ANY COST IN THE BUDGET SPREADSHEET):
EVALUATION/CONTROL:
FUNDING APPROVED:  YES  NO
APPROVED AMOUNT: $ _______________
_____________________________________
__________________________
MANAGER SIGNATURE
DATE
COMMENTS:
DATE COMMUNICATION OF APPROVAL SENT:
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