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CENTER/INSTITUTE APPLICATION FORM (Worcester Polytechnic Institute)

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CENTER/INSTITUTE APPLICATION FORM
Proposed Center Name: ________________________________________________
Director: _______________________________________________________________
Center Mission and Vision:
G
oals and Objectives:
E
valuation Criteria:
G
overnance Structure:
List of Participating Faculty:
(attac
h list as needed)
Name
Position (including rank)
Department(s)/ School(s)
S
pace and Facilities Requirements:
Fundi
ng/Budget:
E
ndorsements
Please include signatures of approval below or append letters/emails of approval from
appropriate Dept. Head(s), and Dean(s). If the Center will be associated with an established
Center or Institute, include an endorsement from the existing Center/Institute Director. If
space assignment is involved, approval from the head of the unit responsible for the space
is essential.
Department
__________________________________
Dept. Head Name __________________________
Dept. Head Signature _____________________________
Date ____________________
School __________________________________
Dean Name __________________________
Dean Signature _______________________________
Date ____________________
Center/Institute (if applicable) __________________________________
D
irector Name __________________________
D
irector Signature _______________________________________
Da
te ____________________
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CENTERINSTITUTE APPLICATION FORM (Worcester Polytechnic Institute)

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Completed 2 February 2021

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