Application Title Page
Partnering with Higher Education for International Development
2002 Special Request for Applications

1. Coordinating institution in the U.S.:

2. U.S. Partnership director name:

Address:

City:

State:

Zip:

Telephone:

Fax:
E-mail address:

3. Partnering higher education institution in USAID-assisted country:

4. Institutional partner(s) partnership director(s) name (add sheets as necessary):

Title:
Address:
City:
Country:
Postal Code:
Telephone:
Fax:
E-mail address:

5. Name of proposed partnership:

6. Strategic Interest Area as named in this RFA:

7. Funds requested of ALO ($125,000 maximum):

8. Cost-share from U.S. institutional partners:

9. Cost-share from cooperating country partners:

10. Other partners (e.g., other higher education institutions, community organizations, state or local government, businesses):

11. Executive summary of the partnership activity and the anticipated results (250 words; attach separate sheet)12. This ALO grant program intends to make use of a private Internet listserve as a means by which important information can be transmitted to partnership directors. All U.S. institutional partnership directors must subscribe.

Do the partnership directors have direct Internet access? ____ Yes ____ No
If not, will access be arranged by December 2002? ____ Yes ____ No

13. Please list any other U.S. federal agencies where you have submitted this particular proposal or any similar/overlapping application for funding. Also, if this proposal is a component of a larger project that has been funded or for which funds are being sought, please explain.

Signatures—An officer from each cooperating institution must authorize this proposal. Repeat the format below to accommodate all necessary signatures.

U.S. Partnership Director (Name, Signature. Date)

U.S. Partnership Director Title

Cooperating Institution Partnership Director (Name, Signature. Date)

Cooperating Institution Partnership Director Title

U.S. Institution CEO (or designee) (Name, Signature. Date)

U.S. Institution CEO (or designee) Title

Cooperating Institution CEO (or designee) (Name, Signature. Date)

Cooperating Institution CEO (or designee) Title

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