Name of MI-ACE Institution *

Institution Mailing Address *

Name of Campus IR #1 *

Phone of Campus IR #1 *

Email of Campus IR #1 *

Name of Campus IR #2 (if applicable)

Phone of Campus IR #2 (if applicable)

Email of Campus IR #2 (if applicable)

Activity Title *

Activity Date(s) *

Activity Location *

Grant Amount you are Requesting (range $250-$500) *

Please also indicate below the reason for your Micro-Grant request/demonstrate need.

Professional Development/Program/Activity Description (Who, What, When, Where, Why and How) *

Describe your plans for publicity and promotion of this Professional Development/Program/Activity *

What do you hope to accomplish? List specific goals, objectives, expected outcomes, and explain how the program/activity supports the MI-ACE mission. *

List the methods of evaluation that will be used for this Professional Development/Program/Activity. *

Will your Institution be providing matching funds? *
- Select Option Yes No

If your Institution will be providing matching funds, indicate if funds are monetary or in-kind (describe type of in-kind match). *

Proposed Program/Activity/Event Budget *
Please upload a file with the extension .csv, .xls, .doc, .pdf, .rtf, .docx, .xlsx, .pub, or .txt with a maximum size of 1 MB (1024 KB)

5. I/We understand that a follow-up grant report is required to be submitted within 45 days following the conclusion of the approved program/activity/event and that the report must include the details described in the Required Follow-up Grant Award Report *
- Select Option Yes No

As organizer(s) of this Event, I/we certify this Application is accurate.

Name of IR #1 *

Name of IR #2 (if applicable)

Date *