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):
    
Architecture & Urban Planning
Art & Design
Business Administration
Dentistry
Education
Engineering
Horace H. Rackham School of Graduate Studies
Information
Kinesiology
Law
Literature, Science & the Arts
Medical School
Music
Natural Resources & Environment
Nursing
Pharmacy
Public Health
Public Policy
Social Work
Office of the President
Office of the Provost
Office of Government Relations
Office of the Vice President for Communications
Office of the Vice President for Research (OVPR)
Office of the Vice President for Student Affairs
University of Michigan Health System
University of Michigan - Dearborn
University of Michigan - Flint


 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.]

Architecture & Urban/Regional Planning
The Arts
Business & Industry
Communications
Community Assistance
Culture (American & International)
Education: Early Childhood to Grade 12
Education: Higher Ed
Education: Continuing & Community
Engineering
Environmental
Health & Health Care
Information Technology
Law & Public Policy
Mental Health
Science & Research
Social Services
Teacher Education/Resources
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".

Ann Arbor
Battle Creek
Bay City
Benton Harbor
Detroit
Flint
Grand Rapids
Kalamazoo
Lansing
Marquette
Midland
Saginaw
Sault Ste. Marie
Traverse City
N/A

   Other Cities: 

13. Program Available to these Counties:
     [Please check all that apply.]

14. Program Description: [100 words or less; text automatically wraps]
    After reading the following suggestions, please delete 
all of the text in this box and type in your own program 
description.

Include any business, educational, and societal areas 
to which this program may be of specific benefit.

List cities, especially those not shown above under 
"Major City/Cities Impacted."

List any honors received by this program.


 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]