LIBID
Institution: do not use the / character in the name.
Project manager name
Mailing address
Telephone number (e.g., 555-555-5555)
Fax number (e.g., 555-555-5555)
Email address (e.g., maryc@project.org)
Project title
Provide a one paragraph summary statement (under 200 words) of the proposed project.
What are the characteristics and health issues of the population and/or geographic area where the project will take place?
Provide the numbers and types of health care professionals, librarians, and/or consumers you expect the project to reach.
Why is information outreach needed for the target population? Describe how you determined the need for this project.
What are the specific objectives you expect to achieve with the project?
What methods will you use to reach your objectives?
Explain how you will evaluate the project and describe how you will measure the success for each objective.
Provide a list of the key personnel for the project and describe each person's responsibilities. Please send resume or curriculum vitae for key personnel via mail or fax.
Describe the relevant facilities and resources that will be available to support the project.
What is the schedule for the project? Provide a list of tasks in chronological order and indicate timeline for each task.
If training and/or demonstrations are included as a methodology, describe what will be taught or demonstrated, who will do it, where it will be done, length of class, type of continuing education credit, what training materials will be used, and a description of the target audience for each event.
Personnel cost
Supplies cost
Equipment or Software Cost (Do not include overhead in amount budgeted for equipment.)
Travel
Other cost
Total cost (not to exceed $4,900)
Please supply a budget for up to $4,900, including a brief justification for each expenditure.

Word verification
Type the words you see in the picture below.

Enter reCaptcha code here: