Fillable Ira-application-form-022213 Instructionally Related Activities Funds Request

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Ira-application-form-022213 Instructionally Related Activities Funds Request

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http://www.csuci.edu/ira/index.htm
Application
Instructionally Related Activities Funds Request
2013-2014 Academic Year
DEADLINES: Application Submitted to AVP:
Fall and Academic Year 2013-14: 03/01/13
Spring 2014 deadline: 10/01/13
Submittal Process: Applications must be first be signed by your program chair and then
submitted to the appropriate AVP for approval. AVP’s will next forward application to the
IRA Coordinator for review. If there are questions or concerns, you may be asked for
revisions or additional information. The IRA Coordinator will then forward applications to
the IRA Committee for consideration.
Fiscal Management: Project Sponsor’s program will be responsible for all costs incurred
over and above what is funded through the IRA award and will be responsible for seeing
that any revenue that is intended to offset the amount of the IRA award is transferred
accordingly.
Duplicate requests- if Sponsor is submitting multiple proposals for recurring events
involving speakers, musicians, etc., please combine your requests into one proposal.
Activity Title:
Project Sponsor/Staff (Name/Phone):
Activity/Event Date(s):
Date Funding Needed By:
**Please Note that for Fall Requests the earliest that you will be notified of funding
availability will be early June 2013 and for Spring Requests early January 2014.
Previously Funded? YES NO If Yes, what Semester/Year?
Proposal(s) # _____________
*
If previously funded, please attach copy of post-event IRA Report
Report submitted for previously Funded Activity?: YES NO
Academi
c Program or Center Name:
Estimated total Course Fee revenue:
Amount Requested f
rom IRA:
(Should match “Total Requested from IRA” on Page 5)
Est
imated Number of Students Participating:
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Conditions and Considerations
Please check if any of the following apply to your IRA:
Artist/Performer/Speaker Fees & Honoraria- On the Activity Budget, please indicate
whether the vendor’s price was set by you / CI representative, or is a fee that was set by
the vendor themselves.
Large Event- For a large event, consultation with the campus Event Coordinator’s
office at (805)437-8548 is required.
Equipment Purchase- If requesting large equipment purchase -over $200, or will be a
fixture installed on campus- Project Sponsor must show proof of correspondence with
OPC Administration. In addition, all other purchases must follow Procurement Guidelines.
Field Trip- Sponsor must comply with all policies found at
http://www.csuci.edu/hr/AcademicFieldTripGuidelinesandForms.htm. If approved,
Identified Risks of Participation and Release Agreement must be submitted for each
student to the Program Office (Public Folders-HR Forms).
Involves Human Subject Data Collection for Public Dissemination -Requires IRB
Approval. If Project Sponsor proposes to conduct research with human participants, the
proposal may be subject to Institutional Review Board for the Protection of Human
Subjects (IRB) review. All research that involves any type of interaction with human
subjects – from simple surveys to complex biomedical procedures – must be reviewed
and approved by the IRB prior to starting the research. Data for “Public Dissemination”
indicates interviews/surveys that result in a journal/poster session/newsletter, etc.
Exempt from IRB Approval –If your project is exempt from IRB review, include
copies of correspondence with IRB Board. It is the Project Sponsor’s responsibility
to inquire with the IRB prior to IRA application submission to determine if the
project is exempt from IRB review so that funding is not delayed.
IT Requirements- If your activity has IT requirements, your application requires proof of
correspondence and approval from IT Administration.
International Travel- Requires International Travel application be submitted to Center
for International Affairs. Include copy of CIA budget and course syllabus in your IRA
application.
Risk Management Consultation-Events that involve or engage students directly with a
performer or artist (i.e. in a workshop or other than as a passive audience member) will
require consultation with Risk Management. Requires proof of correspondence with Risk
Management.
Space/OPC Requirements, Infrastructure/Remodel-Requires proof of correspondence
with OPC Administration.
Late Submission - Requires explanation for emergency funding.
Other -
- 3 -
Application
Instructionally Related Activities Funds Request
2013-2014 Academic Year
Requirements and Signatures
Please provide the following in your application:
1. Brief Activity Description. Describe the activity and its relationship to the
educational objectives of the students’ program or major.
2. Relation to IRA to Course Offerings. All IRAs must be integrally related to the
formal instructional offerings of the University and must be associated with
scheduled credit courses.
a. Please list all classes that directly relate to the proposed activity.
b. For each class listed in #2a, describe in detail how exactly the IRA
activity will be integrated with the class’s activities, how often/ on what
expected date(s), and to what extent.
3.
Learning Outcomes. List all expected learning outcomes, as connected
specifically with each course listed in #2.
4.
Activity Assessment. Describe the assessment process and measures that the
program will use to determine if it has attained its educational goals. Please
note that a report will be due at the end of the semester.
5.
Activity Budget. Please enclose a complete detailed budget of the entire
activity. Bold specific items that you are requesting IRA to fund (Page 6).
6.
International Trips. If your event is an international trip submitted through the
Center for International Affairs, you must include a copy of the program
budget as submitted to CIA (to ensure congruency between the two
budgets), as well as a copy of the course syllabus.
7.
Sources of Activity Support. Please list the other sources of funding (including
course fees), and exact expected amounts of additional support for the
activity.
8. Audience/ Marketing/Promotions. Who is your intended target audience? How
will your event be advertised to students?
9.
Sustainability. If appropriate, indicate how the content or delivery of the
project promotes sustainability at CI.
10.
Images. For previously funded IRA activities, include copies of images from
past IRA activity or activities, demonstrating student participation and levels of
students served.
11.
Acknowledgment. Project Sponsor and Program Chair acknowledge that
they have reviewed and accepted the Conditions and Considerations herein.
- 4 -
Signatures and Dates
Project Sponsor
Date
Program Chair/Director Date
Academic Affairs AVP Date
Attach a copy of the completed IRA Excel Budget sheet after this page.
http://www.csuci.edu/ira/application.htm
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Completed 19 February 2020

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