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CONTRIBUTOR FORM

FOHS 2013 WORLDWIDE OUTREACH GRANT PROGRAM
Supporting Educational Needs in Developing Countries
GRANT PROPOSAL FORM

Deadline for Submission: DECEMBER 31, 2013

One letter of support from an individual or organization outside of the organization that is submitting the proposal is required and must be submitted to the Proposal Submission Contact listed below via email or regular mail. Use this form to provide all other required information.

Eligible Organization (select one):
	Qualifying Educational Organization
	Professional Organization
	Non-government Organization
	Non-government Organization Collaborating Center

Contact Information
*Required fields
Project Director:
*First Name:
*Last Name:
Dept./Division:
*Organization:
*Address:
*City:
State/Province:
Zip/Postal Code:
*Country:
*E-mail:
*Telephone:
Other Participants:
Name and title of person authorized to receive funds
First Name:
Last Name:
Title:

Proposal Title:

Program and Proposal Description:
(Do not exceed 1000 words)

Proposal Amount (Maximum Amount - $2,000):

Other Sources of Proposal Support (including amounts):

Proposal Submission Contact:
ACGIH^® International Committee
1330 Kemper Meadow Dr.
Cincinnati, OH 45240 USA
Phone: +1 (513) 742-2020
Fax: +1 (513) 742-3355
E-mail: mail@acgih.org

FOHS has an alliance with ACGIH^®. Visit their website at http://www.acgih.org.