Heritage College Society of Alumni and Friends
Student Funding Proposal Application – Academic Year 2015-2016
Guidelines and Proposal Instructions:






Save all application documents as one PDF before submitting. Do not alter actual application form.
Submit via email to: ou-hcom.alumni@ohio.edu with subject: Student Funding Proposal Application.
Deadline: Minimum of 45 days prior to event/need. For exceptions, you must contact the Director of
Alumni Affairs, Laurie Lach at lach@ohio.edu or 740-593-2151.
Applicants will be notified of funding decision following Alumni Board review and/or within 30 days of
proposal submission.
NOTE: Projects must occur within the Heritage College Academic Year 2015-2016 to be considered
for funding. A total of $5,000 is available for distribution with a maximum award of $1,000 per
proposal. The Society of Alumni and Friends reserves the right to provide partial funding, to deny
requests and to require additional information from the applicant as needed to make a decision.
UPON APPROVAL: The student and/or student organization receiving funding from the Society of
Alumni and Friends will be required to present to the Society of Alumni and Friends Board of
Directors in written and/or verbal form how the funds were used and the results of the project or
efforts undertaken within 30 days of completion or an otherwise reasonable timeframe.
Please fill out the following information:
Name of Proposal:
Name of Applicant(s)
and contact information:
(If a group, provide contact person)
Dates and Duration of Project:
(Must occur within Heritage College Academic Year
2015-2016)
Total Project Cost:
Amount Requested from
Alumni Society:
(How much are you asking for?)
Self-Described Need:
(1 to 5) 1 = low, 5 = high
(numerical score only)
List your type of project:
a) Community and Medical Student Focused
b) Global Health Experience
c) Research Project
d) Medical Conference Presentation Attendance
*Other Funding Confirmed:
(name source and amount)
*Other Funding Applied for:
(name source and amount requested)
**Heritage College Faculty or Staff Contact:
$
$
*If applicable.
**Faculty advisor and/or staff with project oversight.
Heritage College Society of Alumni and Friends
Student Funding Proposal Application
Academic Year 2015-2016
Page 1
Heritage College Society of Alumni and Friends
Please also include the following information on the pages below:
(Each item should be no more than 1 page)
1. Itemized Budget
2. Project Summary:
a. A description and purpose of the initiative
3. Project Testimonial:
a. A summary of your project’s value to the Ohio University Heritage College
of Osteopathic Medicine and the osteopathic medical community.
Itemized Budget
Heritage College Society of Alumni and Friends
Student Funding Proposal Application
Academic Year 2015-2016
Page 2
Heritage College Society of Alumni and Friends
Project Summary
Heritage College Society of Alumni and Friends
Student Funding Proposal Application
Academic Year 2015-2016
Page 3
Heritage College Society of Alumni and Friends
Project Testimonial
Heritage College Society of Alumni and Friends
Student Funding Proposal Application
Academic Year 2015-2016
Page 4