Fillable Arkansas Tech APPLICATION FOR PROFESSIONAL DEVELOPMENT GRANT COVER PAGE

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Arkansas Tech APPLICATION FOR PROFESSIONAL DEVELOPMENT GRANT COVER PAGE

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REQUIRED COVER PAGE
APPLICATION FOR PROFESSIONAL DEVELOPMENT GRANT
**All questions must be completed to be considered for grant award.
Choose one:
[ ] Creative Activity
[ ] Research Activity
[ ] Professional
Enhancement Activity
Application Deadline Date: _____________ (i.e. October 1, February 3, or April 15)
Date of Last PDG Award (Semester and Year awarded): ______________________________
Date of ATU Faculty Appointment (Semester and Year): _______________________
1. Project Title: _________________________________________________________________________________________
2. Name of Principal Investigator/Project Director: _________________________________________________________
3. Collge (abbrev): _____________ 4. Department: __________________5. Campus Mail Address: __________________
6. PI/PD Campus Phone: ____________ 7. Amount Requested: $____________ 8. Total Cost of Project: $______________
9. Will total funds awarded be expended by June 30
th
of the current fiscal year: Yes______ No ______
10. If not, what is the total to be expended this fiscal year: $_______________
11. What is the total to be carried over to the next fiscal year: $___________________ (if approved by the VPAA)
12. Project Completion Date: _________________________ 13. Travel Dates:______________________
(if applicable)
14. Does this project involve:
Yes No
[ ] [ ] human subjects?
[ ] [ ] animals/animal care facility?
[ ] [ ] radioactive materials?
[ ] [ ] hazardous materials?
[ ] [ ] biological agents or toxins restricted by the USA Patriot Act?
[ ] [ ] copyright or patent potential?
[ ] [ ] utilization of space not currently available to the PI/PD?
[ ] [ ] the purchase of equipment/instrumentation/software currently available to the PI/PD?
NOTE: If the answer is “yes” to any of the above questions, the investigator must attach appropriate documentation of
approval or justification for use/purchase.
SIGNATURES
Department Contribution (if applicable): $_________
_______________________________________
Account Number: _____________________________ Chairperson Date
College Contribution (if applicable): $_________
_______________________________________
Account Number: ____________________________ Dean Date
This Section to be completed by the Office of Academic Affairs
Previous PDG Award final report received: Yes_____ No_____
PDC Committee Award Recommendation: Yes____ No____
PDC Committee Proposal Rank: ______ of _____ Total Proposals.
Recommendation of VPAA: Yes____ No _____ Recommendation of President: Yes____ No _____
Award Date: _______
PROPOSED BUDGET
PROFESSIONAL DEVELOPMENT GRANT
1. Travel (please list expenditures broken down for the length of the trip: e.g., hotel =$90x5=$450):
Dates of Travel:
Airfare (include carrier and flight information): _______________________
Hotel: _______________________
Meals for Duration of Travel: _______________________
Mileage Reimbursement = 42 cents/mile: _______________________
Incidentals 1(___________): _______________________
Incidentals 2(___________): _______________________
Total Estimated Travel Expenses: $ _______________________
Currently Approved Per Diem Rates are on a city by city basis. Please check specific cities for
appropriate meal allowances through the GSA Reimbursement Website:
http://gsa.gov/portal/category/104711
2. Graduate assistant stipend ____________
Fringe benefits: salary X 0.0003 ____________
3. Non-work study stipend ____________
Fringe benefits: salary X 0.0003 ____________
4. Development Supplies (please list items to be purchased and estimated price per item including
taxes and shipping, if appropriate)*:
Item No. 1 (e.g., software) Estimated Price ____________
Item No. 2 (e.g., copying costs) Estimated Price ____________
Item No. 3 Estimated Price ____________
Item No. 4 Estimated Price ____________
Total estimated Development Supplies: $____________
5. Capital Outlay (please list items to be purchased and estimated price per item including taxes and
shipping, if appropriate)*:
Item No. 1 Estimated Price ____________
Item No. 2 Estimated Price ____________
Item No. 3 Estimated Price ____________
Total estimated Capital Outlay: $____________
*Items purchased under $5,000 (including taxes and shipping) are considered supply items. Capital Outlay items are those
which cost $5,000 (per item) or more (including taxes and shipping). Please contact the Purchasing Office for questionable
items.
6. TOTAL PROPOSED BUDGET $____________
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Arkansas Tech APPLICATION FOR PROFESSIONAL DEVELOPMENT GRANT COVER PAGE

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Completed 16 May 2020

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