Application Deadline:
Please print legibly in black ink the answers to the following questions:
Name: Class:
Permanent (not Swarthmore) Address:
Phone:
Total funding requested: $
Dates of service: from____________ to___________________
Do you plan to take courses at Swarthmore during your service?
Do you plan to live at home during your service?
Have you ever received a Swarthmore Foundation grant? If yes, when?
Agency/Organization:
Name of agency or organization with which you intend to work:
Address and phone number of agency supervisor:
Will you receive pay for your services? If so, how much pay will you receive?
Have you volunteered at this or a similar agency before?
How many hours per week do you plan to work with this project?
Funding
Please provide us with details of your expected project and living expenses. If you expect to earn an income while working on your project or if you will have support from others, please include those resources below. (If you currently receive financial aid from Swarthmore College, you might consider consulting Laura Talbot, Financial Aid Director, about the possibility of receiving Work Study funds.) Be realistic about the amounts you will spend for food, rent, and basic needs.
Remainder
Requested
From
Expected Expenses Expected Resources Foundation
from from from
monthly X # of = project parents your other
expense months total earning sources *
rent $ ______ X ______ = $ ______ $ ______ $ ________ $ ______ $ ______
utilities $ ______ X ______ = $ ______ $ ______ $ ______ $ ______ $ ______
food $ ______ X ______ = $ ______ $ ______ $ ______ $ ______ $ ______
local trans-$ ______ X ______ = $ ______ $ ______ $ ______ $ ______ $ ______
portation
or gas
project materials; please detail
____________________ $ ______ $ ______ $ ______ $ ______ $ ______
____________________ $ ______ $ ______ $ ______ $ ______ $ ______
_____________________ $ ______ $ ______ $ ______ $ ______ $ ______
_____________________ $ ______ $ ______ $ ______ $ ______ $ ______
_____________________ $ ______ $ ______ $ ______ $ ______ $ ______
TOTALS $ ______ $ ______ $ ______ $ ______ $ ______
requested
from
Foundation
* Please describe "other sources" if any are listed:
I have thoroughly read and understood the guidelines set out by the Swarthmore Foundation. I agree to:
1. submit an address and phone number where I can be reached during my community service work period;
2. keep a careful financial record of all expenses and expenditures; and
3. submit a 3-5 page report detailing my service experience.
4. Notify the Swarthmore Foundation Board of any changes in my project from my proposal.
I agree to comply with these guidelines if I receive a Swarthmore Foundation grant.
Applicant's signature: Date:
Please respond briefly to the following questions on separate pages.
Nature and Goals of the Project
Please provide a brief description of your proposed activity, addressing the following questions:
1. What tasks will you perform?
2. What are your goals for this project?
3. If the geographic location is not local or in your home town, what is the rationale for this work site?
4. Is there any correlation between this project and your academic studies? If so, please explain.
If you will be working with an existing agency or organization:
1. What do you know about this agency and how did you find out about it?
2. How well defined are the agency's expectations for your work?
If you are creating a new project, please respond briefly to the following questions in addition to the questions above:
1. How do you envision the program in operation (day-to-day operation), reacting to problems (what are the expected problems?), credit and recognition, recruiting a diverse group of participants?
2. Does anyone in this area offer a program similar to yours and, if so, how does yours differ?
3. Have you been in touch with any similar programs for advice on difficulties of operation or problems working in the community?
4. What kind of guidance and support will you have for your project before and during its operation?
5. What will happen with the project after you leave?
Target Population
1. What is the target population of the community in which you plan to serve, and how directly would you work with this population?
2. What are the needs of the community in which you plan to serve, and what impact would your internship or project have on the targeted participants?
3. How have you involved the community in developing your project proposal to ensure that it meets the needs of your target population?
Training
1. Will you receive agency training? If so, what will be the extent of that training and who will provide it?
2. If you are not working with an existing agency, what kind of training will you receive?
Evaluation
1. What are the key objectives and measurable outcomes of your project?
2. How do you plan to evaluate the success of your program?
3. How does your supervisor at the agency plan to evaluate the success of your program?
4. Most importantly, will the target population evaluate your program? How will they evaluate it and how will they communicate this to you?