All applications should be typed and submitted using this form.
This publication was created by the CCAC Office of Institutional Advancement & External Relations (Advancement).
John Dziak Faculty Development & Engagement Fund Application-P1-POD-TSM-TSM-AUG12
Application
Name: Campus: Date:
Title of your project: Requested amount:
Course(s) related to your project:
This project is for the:
spring term (year)
fall term (year)
Student engagement can be exhibited in a number of ways. Please specify how you plan to engage the students by
checking all that apply.
Enhance student-faculty interaction, e.g., will give first 20 students to meet with me during office hours on
course review questions a $25.00 bookstore voucher.
Service learning, e.g., will give students transportation money to the Greater Pittsburgh Food Bank to
re-package food and research the nutritional value of food items sent to shelters.
Civic engagement, e.g., will organize a voter registration campaign in a local community center.
Group work, e.g., will purchase team building software to be used for project planning.
Project based learning, e.g., students will develop a children’s story hour program for a neighborhood library
and implement it for three months.
Other
Please also attach a description of the project that includes: 1) details of project parameters; 2) project goal(s);
3) measurable project outcome(s); and 4) how you will assess the success of the project.
The attachment should be no longer than two pages double spaced.
Commitment to the Program
As a Dziak Fellow, I agree to complete the project for which funds have been requested within one semester and to
share the results of the project for increasing student engagement with the college community.
Signature of applicant: Date:
I have reviewed this application and recommend it for funding as it is viewed as being within the scope of the
provisions of the John Dziak Development and Engagement Fund and the policies of the college.
Signature of campus
dean, Academic Affairs: Date:
Please return the completed application by December 5 to:
The John D
zi
ak Faculty Development and Engagement Fund
CCAC Educational Foundation
Byers Hall, 808 Ridge Avenue
Pittsburgh, PA 15212-6097
