Community-Based Research Program Application Form

Please review the application process for CURA Community-Based Programs before completing this form.

This application form serves the Community Assistantship Program (CAP), Neighborhood Planning for Community Revitalization (NPCR) and Communiversity.

Contact Information

Please select from the following list the CURA program to which you are applying for assistance (if you aren't sure which program is appropriate, choose "Unsure" and we'll select the appropriate program for you).
Organization Name:
Street Address:
City:
State:
Zip:
Main Phone (include area code):
Main E-mail:
Main Fax:
Web Address (if any):
Location where student will work
(if different from address above):
Which of the following best describes your organization:
If you chose "Other," please explain:
Primary Contact Person at Organization:
Phone (include area code):
E-mail:
Project Supervisor:
(person who will directly supervise the student):
Phone (include area code):
E-mail:
Executive Director or Board Chair:
Phone (include area code):
E-mail:

Organization Information

Q1a. Briefly describe your organization.

Q1b. Briefly describe the specific neighborhood, community, or group that will be served
by the proposed project (including, if possible, demographic and geographic description).

Project Description

Q2. What is the title of your project?

Q3a. Describe the project for which you are seeking a student researcher.

Q3b. What specific question(s) do you want the research to help answer?

Q3c. What will be the final research product?

Q3d. How will your organization use the results of the research to benefit the
neighborhood, community, or group you serve?

Project Participants

Q4a. How will the people who are served by your organization be involved in this
research project, especially those affected by the results?

Q4b. Does this project involve other organizations beyond yours? If so, please describe
these organizations and how they will contribute to the project.

Responsibilities

Q5. Describe the duties and responsibilities of (5a) the student research assistant and
(5b) the project supervisor, including the specific tasks each will be expected to complete.
(Please answer both 5a and 5b in the box below.)

Q6. What specific skills, experience, and qualifications will be required of the
student research assistant? (This information will be used to recruit a qualified
student for your project, if funded.)

Support

Q7a. What material support (e.g., desk, telephone, access to a computer, access to
a copy machine, etc.) can your organization provide for the research assistant?

Q7b. What financial support (e.g., contributions toward the cost of student wages, funds
for travel or other expenses, etc.) can your organization provide for this project? (Financial |
contributions from organizations are important to leveraging our resources to serve more projects and
are always appreciated.)

Q7c. What additional support will be required for this project that your organization
cannot provide, and how might it be obtained?

The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race , color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran status, or sexual orientation.

If you have problems with this form, or would like to communicate with a person directly, contact: CURA Web Manager