UC Davis Community Partner Recognition Grants Pilot Program Application 2024

Community Partner Recognition Grant Pilot Program Application

Thank you for your interest in applying for the UC Davis and UC Davis Health Community Partner Recognition Grant Pilot Program Application.

Applicant Information

Full Name

Email Address

Phone Number

Affiliation

UC Davis

UC Davis Health

Other (please specify)

Office / Dept / Center (please do not use acronyms)

Position/Title

Activity Information

Activity Title

Activity Start Date (if applicable)

Activity End Date (if applicable)

Is this a new, existing or an evergreen activity?

Brief description of the activity and anticipated outcome(s). Please share how community partner participation strengthens the activity? (500 words max):

How does this activity integrate community voices and input? (500 words max)

Describe how this activity is community centered and/or mutually beneficial. (500 words max)

Please highlight how the activity benefits non-university communities, involves non-profit or community-based organizations, and integrates community input as key to selection.

Please provide names and affiliated organizations of community partners:

Request

Why are these funds necessary for your activity? Please share why recognition or support for community partners is not currently included in your existing budget?

Budget Request

Please upload your budget using the budget worksheet.

Budget Narrative

Please provide a description of how funds will be used.

Additional Information

Is there any additional information you would like to provide about your activity or request?

Acknowledgment and Submission

I acknowledge that the information provided in this application is accurate and complete to the best of my knowledge. I agree to provide a final report describing how funds were used, and participate in the evaluation of the community partner compensation pilot. I understand the listed community partners will be contacted to participate in the evaluation process as well.

I agree.

Principles of Community

All faculty, students and staff involved in or supported by PSE and HEDI programs are expected to abide by and support the UC Davis Principles of Community. In the event that a participant is found to have violated University policy impacting the integrity or effectiveness of programs funded or supported by PSE or HEDI, such funding and support is subject to revocation. Furthermore, if a participant is found to be under investigation for a purported violation of University Policy, interim measures including suspension of funding, support, co-sponsorship, or awards may be implemented as needed.

I have read the UC Davis Principles of Community and understand this policy.

Do not fill out this field