Faculty/Staff Technology Support Initiative Application Form 2021-2022

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State University of New York - College at Brockport

Page 1 of 3 - Contact Information

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Proposal Title *
APPLICANT INFORMATION
Applicant Name Applicant Name * First Last
Applicant's Title *
Applicant Phone Applicant Phone * - ### - ### ####
Applicant's e-mail *
Applicant's Department/Division *
Funds Requested by Proposal * $ Dollars . Cents
SPONSOR INFORMATION
Sponsor: Department Chair/Unit Head Sponsor: Department Chair/Unit Head * First Last
Sponsor E-mail *
Sponsor Phone Sponsor Phone * - ### - ### ####
Sponsor's Department/Division *
Department Dean / Division VP Department Dean / Division VP * First Last
Dean/VP E-mail *
Dept. matching funds (10%) authorized: $ Dollars . Cents
If awarded, departmental matching funds to be transferred from Acct.#: *
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