Non-Affiliates Proposal Application

Proposal Submission/Funding requests

This form must be completed for any funding requests such as travel, programs, scholarships,
supplies, and materials, etc., or for any proposal ideals.

Required fields are indicated by *

Last name * :

First name * :

Address :

City :

State :

Zip :

Email address * :

Phone number * :

Fax number :

Title of proposal or funding request:

Category :
Pre-College/Informal Education
Higher Education
General Public

Abstract (150 word maximum) :

Start date :

Ending date :

Amount of funding requested :

Date funding required :

Check payable to :

Relevance to the National Aeronautics and Space Administration (NASA) :

Timeline (give start date, end date and details on milestones) :

Personnel (list all individuals working on the project and a brief description of their duties) :

Budget and/or resources needed (include details of cost and list any funding from other sources) :

Additional Required Information :

Numbers of students graduate * :

Numbers of students undergraduate * :

Numbers of K-12 * :

What are the grade levels ? (K-12 only) * :

Number of teacher participants ? * :

Number of parents involved in project (K-12 only) * :

Number of administrators involved in project *:

Number of others involved in project * :

Will this program be evaluated or involve tracking. If so, please explain * :

Please confirm by signing below -
• The Georgia Space Grant Consortium will be included in all publicity as a sponsor or co-sponsor of your program.
• A complete accounting of expenditures will be given to the GSGC
For a copy of the GSGC official logo, email gsgc@gatech.edu .

Initials * :

Date * :