Shriver Center

Name of Course/Project*

Type of Grant* Course | Project (Connected with a course)
Project | Program (Not connected with a course)

Grant Amount Requested*

Course Number and Title (If "Course | Project" selected above) If the course number is not available, please share what level the course is and how it relates to the department's curriculum.

First Name*

Last Name*

Email Address*

Email Address (Again)*

Campus Role* Faculty
Staff
Undergraduate Student
Graduate Student

First Name	Last Name	Email Address	Campus Role
			Faculty Staff Undergraduate Student Graduate Student
			Faculty Staff Undergraduate Student Graduate Student
			Faculty Staff Undergraduate Student Graduate Student

Department/Organization Name* The department/organization that will receive and manage the awarded funds. If you are not affiliated with a department/organization, complete this form anyway and someone from our committee will get in touch with you.

Department/Organization Chart String Number* If you are allocated a grant, the funds will be transferred to this chart string number. If you do not know your chart string number, enter a "?" in this field and someone from our committee will be in touch with you.

Department/Organization Chart String Account Code* If you do not know the account code, please enter "1111" for now.

Course/Project/Program Goals and Expected Outcomes* Please provide a brief description that highlights your goals and expected outcomes. If you are applying for a follow up grant, please briefly describe what the original grant was and how this new grant will support new aspects or elements of the work. This description will be posted on the BreakingGround website if you are awarded grant funds. You will be given an opportunity to make edits before it is posted.

Course/Project/Program and BreakingGround Values* Please describe how your project or course aligns with BreakingGround values.

Progress Assessment* How will you assess progress towards your expected outcomes?

Participant Communities* Please check all communities where the participants will be working.
UMBC Main Campus
UMBC Shady Grove Campus
Off-Campus

Community Partner If you selected "Off-Campus", please provide a community partner name and address/neighborhood (if applicable).

Timetable* Approximate date(s) of implementation/timetable.

Beneficiary* How did you determine the need for this course/project and who will benefit?

Are students involved in your project?* Yes
No

If so, in what capacity?

Involvement* How will you encourage participants to remain involved with this social issue/community beyond this course/project?

Reflection* Describe how participants will reflect on their experiences. Please share any questions, activities, or assignments you plan to implement for reflection.

Budget Form

Involvement* How will UMBC participants and community partners be involved in the design, implementation, and evaluation of the course/project?

Promotion Methods* If you are selected for the BreakingGround grant, we will promote your course/project on the BreakingGround website. How else will your work be shared/promoted to UMBC and/or the surrounding community?
Social Media
Published Products
Presentations
Community Gatherings
Other

Websites/Publications If applicable, please list any websites or publications that you will be using to promote your course/project.

Additional Document If you have an additional document you wish to submit with your proposal, please upload it here.