Local Section Innovative Project Grant (IPG) Application Form

Sponsoring Local Section: *

Submission Date: * +

Title of Project: *

Brief Description: *

0/400 characters

Project Coordinator Information:

Name: *

Address: *

Tel: *

Email: *

IPG Information:

Does the Section currently have an active IPG funded by LSAC? *

If yes, indicate submission date: +

Name of Current Section Chair: *

Current Section Chair Email Address: *

Letter of Support from Local Section attached? (If the Section Chair is the Project Coordinator, a member of the Executive Committee must submit the support letter.) *

Submitting a letter of support from the active local section chair is required. If one is not provided through this application, you will need to send it via an email attachment to lsac@acs.org by the closest submission deadline (January 18 or June 30).

Upload Local Section's letter of support here (acceptable formats: .pdf, .doc, .docx).

The applicant must: *

(1) assure that they have identified and selected low-risk activities for their project

(2) recognized and eliminated high-risk activities and demos, and

(3) considered strategic changes to activities and demos to minimize the likelihood of injury and promote a culture of safety, according to the ACS (https://www.acs.org/content/acs/en/education/outreach/safety.html)

IPG Co-Sponsors:

Letter(s) of support from your co-sponsors attached? *

Submitting a letter of support from co-sponsors is required if the local section is partnering with one (or more) on this project. If one is not provided through this application, you will need to send it via an email attachment to lsac@acs.org by the closest submission deadline (January 18 or June 30).

Upload co-sponsor's letter(s) of support here (acceptable formats: .pdf, .doc, .docx).

Which groups are co-sponsors? *

Specify partnership(s): *

0/150 characters

Full Description of Project or Event:

What are the project's goals/objectives? *

0/1000 characters

How is this project consistent with your local section’s strategic plan? *

0/1000 characters

Justify how the project is innovative for your local section or a unique one-time opportunity. *

0/1000 characters

How will this project stimulate local section members to become and remain involved? *

0/1000 characters

What is the project's plan of action? Please include probable date(s). *

0/1000 characters

Identify target audience(s) and estimate the number of people to be reached. Estimate the number of members involved in organizing the project. *

0/1000 characters

How will IPG funding seed continuing events following the completion of this project? *

0/1000 characters

Budget:

Please complete the budget table below. Awards are made up to $3,500 (increased from $3,000). Include expenses and provide brief justifications. Note source of additional funds if budget exceeds $3,500. Some items that cannot receive IPG funding are honoraria; alcoholic beverages; meals for local section members; or pass-through donations to other individuals or organizations.

If the spaces below are insufficient, you may also upload an itemized budget spreadsheet with explanations (acceptable formats: .xls, .xlsx).

NOTE: for this form to calculate correctly below, enter dollar amounts without commas and without dollar signs.

Item:

Expense:

Justification:

Item:

Expense:

Justification:

Item:

Expense:

Justification:

Item:

Expense:

Justification:

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Expense:

Justification:

Item:

Expense:

Justification:

Additional funds requested from other sources:

Justification:

Project Total:

$0.00

Total Requested from LSAC:

$0.00

Evaluation Plan:

How do you plan to evaluate the success of your event? *

0/500 characters

What tools will you use to measure success of event (i.e., surveys)? *

0/500 characters

How will you use the data captured for future planning? *

0/500 characters

Questions? Contact lsac@acs.org.