Please read the Application Instructions carefully before starting this application.

1. PRIMARY APPLICANT INFORMATION: (Please attach the primary applicant’s resume.)

Name:

(Family Name) (First Name) (Middle)

Gender: Female Male

Email:

Phone Number:

Home Address:______

2. INSTITUTIONAL INFORMATION:

Institutional Address:

University Name:

Division/Department:

Current Position Title:

Street and Number:

City:

Contact information for Dean representing applicant’s department or college: Name:

Work telephone: E-mail:

3. PROJECT BACKGROUND INFORMATION:

Project Title: Project Focus: What academic department or office will participate in this program? If multiple academic departments, please list all involved:

Project Area: Please select the area of collaboration for this grant:

Focused capacity building in faculty instructional strategies in a specific academic department Review and update the curriculum for a specific degree program Collaborative Research University Administration Industry/Private Sector Engagement Establishment of distance learning programs Development of information systems to establish digital record keeping; Modernization of libraries and publication resources Development of career advisory services on campuses Counseling and intervention services on campuses for victims of violence and other psychological distress Initiatives to promote tolerance and peaceful activities on campuses Activities to build youth-based approaches to countering violent extremism. Other

4. PROJECT COLLABORATORS: Please list all internal and external university partners/collaborators for this project. A U.S. university partner is not required to be named. However, if you would like to collaborate further with an existing U.S. university partner please list the name of the U.S. university (and contact info) below. If you have additional collaborators you can include them on an additional page.

Name:

Position:

Project role:

Work telephone: E-mail: Name:

Position:

Project role:

Work telephone: E-mail:

Name:

Position:

Project role:

Work telephone: E-mail:

Name:

Position:

Project role:

Work telephone: E-mail:

5. PROJECT DESCRIPTION: Please describe your small grants project by answering the following questions. Please be sure to answer all questions in detail. You may attach additional pages if necessary.

A) Please describe the purpose of this grant in detail. B) How would your proposed project help your university?

C) What resources does your university currently possess that will help you in implementing your proposed project? D) What are three results that will show that this project is successful?

E) Describe in detail specific steps or activities you will take to successfully complete this grant. F) Who will benefit from your proposed project and how? Please indicate the approximate projected numbers of direct participants and indirect beneficiaries. (For example, X faculty participants will benefit directly from participating in proposed activities by learning new methods of instruction, XX students will benefit from changes in faculty instructional methods)

 ____number of faculty members will benefit directly from participating in proposed activities by (explain how faculty members will benefit from participation) ______

 ____number of departments will benefit from proposed activities by (explain how departments will benefit from participation) ______ ____number of students will benefit from proposed activities by (explain how students will benefit from participation) ______

G) How will you make sure this project continues after the small grant ends? What resources will be needed from your university to ensure this? Who in your university will help make sure this project continues? APPLICATION CHECKLIST

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

Have you completed the entire application form in English electronically?

Have you made sure your application complies with the allowable and non-allowable expenses under this grant?

COMPLETE GRANT APPLICATION INCLUDING:

Application Form

Workplan

Budget Form

Budget Narrative (brief description of budget line items)

Resumes (including project responsibilities)

Letter of support from Iraqi University President

Letter of support from Dean

I have completed and enclosed all items checked above. (Please type your name and sign below.)

First Name, Last Name Signature