George Mason University
Instructional Resource Center

*Today's Date: Month / Day / Year

*Client Information:
(Please provide information for primary contact person)

Faculty/Staff Name:
Department Name:	Select Your Department... College of Arts & Science College of Nursing & Health Science College of Visual and Performing Arts College of Education and Human Development School of Computational Sciences School of Information Technology & Engineering School of Law School of Management School of Public Policy Institute for Conflict Analysis & Resolution Other Department
	If 'Other Department' selected, please specify below.
Other Department:
College Name:
Course(s) Name:

Phone Number:

Email:

G Number:

Budget Code:

Additional Contact(s):

Name1:		Contact Type1:	Select Contact:... Graduate Assistant Faculty Member Staff Member Work Group Other
Phone1:		Email Address1:
Name2:		ContactType2	Select Contact:... Graduate Assistant Faculty Member Staff Member Work Group Other
Phone2:		Email Address2:
Name3:		Contact Type3:	Select Contact:... Graduate Assistant Faculty Member Staff Member Work Group Other
Phone3:		Email Address3:

*Project Plan of Work:
Include start and finish dates, milestones, estimate the number of lab time and the technical assistance you will need. (Use additional space if needed.)

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*Abstract:
Describe your project including purpose, audience, significance, due date, etc. (Use additiontal space if needed.)

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