Request for Equipment Matching Funds

Forward this request to John Poate. If you have any questions, please contact Dr. Poate at ext. 3255.

Principal Investigator:                                                                                                    

Equipment requested:                                                                                                    

Proposal due date:                                     Expected decision date:                             

Agency:                                                                                                                          

Solicitation Number:                                                                                                      

Amount requested (limited to $75,000 or less):

Total equipment cost:                                                                                                    

Cost share provided by Department, Division or Center:                                               

Cost share requested from Equipment Match account:                                                 

Total amount of proposal:                                                                                             

Indicate where the equipment will be located and
describe anticipated use:                                                                                              

Estimated yearly maintenance (and upgrade) costs and
source of funds:                                                                                                             

Will the equipment generate funds that could be used to
reimburse CSM for the cost share?                                              Yes

If so, explain:                                                                                                                 
                                                                                                                                       
                                                                                                                                       

Is this the first, second or third (or more) submittal of this proposal?                            
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Copyright 1999 [OrganizationName]. All rights reserved.
Revised: October 02, 2007