Community Assistance Directory

Main Page


Program Entry Form
for UM Program Managers

Thank you for your interest in submitting a UM program to the Community Assistance Directory! Before you begin, please read the Submission Guidelines page. If you have any questions, please contact the State Outreach office for help at (734) 764-9256, or michigan.outreach@umich.edu.

When finished, press the "Submit Form" button. You will immediately see a preview of how your program entry will look in the directory (pending approval).


Administrative Information


 1. Program Manager:
a. Name: [example: Jane Doe]
b. UM Address: [complete U.S. mail address, including campus ZIP]
c. E-mail:
d. Will the Program Manager accept public contacts at this e-mail address? Yes No
e. UM Phone: [example: (734)764-9256]
f. Will the Program Manager accept public contacts at this phone number? Yes No
g. If yes, during which days/times? [example: M-F, 8:00-5:00] 2. Public Contact Person (if different from Program Manager):
a. Name: [example: Jane Doe]
b. UM Address: [complete U.S. mail address, including campus ZIP]
c. E-mail:
d. UM Phone: [example: (734)764-9256]
e. Public contacts accepted by: E-mail Phone Both
f. During which days/times? [example: M-F, 8:00-5:00] 3. Sponsoring Service Unit(s): 4. Sponsoring Department Involved: [Please do not use abbreviations.] 5. Other UM Units Involved: [Please do not use abbreviations.] 6. Sponsors or Collaborators (outside of the University): [Please do not use abbreviations. For internal [UM] viewing only.] 7. Funding Sources: [Please do not use abbreviations. For internal [UM] viewing only.]

Program Information

8. Program Title: [Type full program name, followed by acronym in parentheses.] 9. Is this primarily a research program? Yes 10. Effective Dates of This Program (list beginning and ending dates): [examples: 03/01/1996 to 03/15/1996 or 03/01/1982 to Ongoing] [Note: The year must use all four digits -- "1996" not "96"] 11. Subject Area(s) Covered: [Please check all that apply.]
  1. Architecture & Urban/Regional Planning
  2. The Arts
  3. Business & Industry
  4. Communications
  5. Community Assistance
  6. Culture (American & International)
  7. Education: Early Childhood to Grade 12
  8. Education: Higher Ed
  9. Education: Continuing & Community
  10. Engineering
  11. Environmental
  12. Health & Health Care
  13. Information Technology
  14. Law & Public Policy
  15. Mental Health
  16. Science & Research
  17. Social Services
  18. Teacher Education/Resources
  19. Web-based Program
12. Physical Location of Program: [Please check all that apply.] NEW: In order to track and search outreach projects that are currently active in a specific city, or cities, please indicate where your program is engaged today. If your program is available, but simply not active in a Michigan city today, simply indicate "N/A".
  1. Ann Arbor
  2. Battle Creek
  3. Bay City
  4. Benton Harbor
  5. Detroit
  6. Flint
  7. Grand Rapids
  8. Kalamazoo
  9. Lansing
  10. Marquette
  11. Midland
  12. Saginaw
  13. Sault Ste. Marie
  14. Traverse City
  15. N/A
Other Cities: 13. Program Available to these Counties: [Please check all that apply.]
Alcona Dickinson Lake Oceana
Alger Eaton Lapeer Ogemaw
Allegan Emmet Leelanau Ontonagon
Alpena Genesee Lenawee Osceola
Antrim Gladwin Livingston Oscoda
Arenac Gogebic Luce Otsego
Baraga Grand Traverse Mackinac Ottawa
Barry Gratiot Macomb Presque Isle
Bay Hillsdale Manistee Roscommon
Benzie Houghton Marquette Saginaw
Berrien Huron Mason St. Clair
Branch Ingham Mecosta St. Joseph
Calhoun Ionia Menominee Sanilac
Cass Iosco Midland Schoolcraft
Charlevoix Iron Missaukee Shiawassee
Cheboygan Isabella Monroe Tuscola
Chippewa Jackson Montcalm Van Buren
Clare Kalamazoo Montmorency Washtenaw
Clinton Kalkaska Muskegon Wayne
Crawford Kent Newaygo Wexford
Delta Keweenaw Oakland

14. Program Description: [100 words or less; text automatically wraps]
    

 15. URL for your Program's Web Page [if applicable]:
    

 16. Program Graphic: [Maximum 150x150 pixel GIF or JPEG file]
     File to upload: 


Form completed by: Department: Phone: [example: (734)764-9256] E-mail: Today's Date: [example: 03/01/1996]

Thank you again!

If you have questions about how to fill out this form, please contact Linda Scharer at (734) 764-9256, or michigan.outreach@umich.edu.


Questions or comments?
E-mail us at:
michigan.outreach@umich.edu
Copyright © 1996, The Regents of the University of Michigan