Association of Faculty and Friends 2021 Grant Request
Please indicate on line if not-applicable
Title of Grant Proposal/Study
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Funding request category:
Clinical Care
Medical Education
Research
Community Outreach
Global health
Applicant's Name
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Applicant's Title (MD, PhD, RN, etc.)
Department Name
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Department Chair/Supervisor
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Applicant's Phone Number
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Applicant's Email
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Applicant's Mail Code
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Please enter College of Medicine (COM) or Penn State Health Milton S Hershey Medical Center (HMC) cost center where the money will be disbursed.
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Please verify cost center number with department finance liaison.
Department Financial Administrator's Name
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Financial Administrator's Phone Number
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Financial Administrator's Email
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Is your request
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A new application?
A proposal for continued funding?
A previously unfunded AFF request?
If previously funded, what year(s) were you funded?
Previously funded amount?
Total amount you are requesting
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Requests for funding is up to $10,000 for each grant
List the other funding sources you have pursued and outcome of request
Number of persons to benefit from this allocation request and description of the population.
Equipment – itemize the purpose of the item(s) and explain why it cannot be purchased under your department Budget
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Patient Service - itemize the expense and purpose.
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Patient Education - itemize the expense and purpose
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If you are requesting funding for brochures or educational materials, please provide a sample of what you are requesting. Please verify that requested printing is not available through the hospital print shop and provide a price quote from a vendor reflecting the cost per item.
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Staff Development - itemize the expense and purpose.
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Other expenses (not described above) - please itemize expense and purpose.
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Summarize (500 words or less) your funding request and its specific goal. Please include how the request supports the AFF mission.
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Our mission is to support and promote medical education, research, clinical care and scholarship; provide a community of friendship to our members through interest groups; and to serve the needs of the community of which we are a part. * As a rule AFF does not fund lodging, food costs or computer hardware.
If necessary, upload any additional documentation that supports your request.
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