Maryland E-Nnovation Initiative Program

Application & Instructions

401 East Pratt Street, Baltimore, Maryland 21202 www.business.maryland.gov

J. Lawrence Hogan, Governor |Boyd Rutherford, Lt. Governor R. Michael Gill, Secretary

MARYLAND E-NNOVATION INITIATIVE PROGRAM

FORM 1 – APPLICATION FOR ALLOCATION OF MATCHING FUNDS

APPLICATION FOR ALLOCATION IN FISCAL YEAR ENDING JUNE 30, 20__

WARNING: False statements made knowingly and willfully in this application, including affidavits or other supporting documentation submitted herewith, are punishable by law. All statements and documents are subject to verification.

1. Full Legal Name of Nonprofit Institution of Higher Education(“NPIHE”)

2. Principal Place of Business Address

City State Postal Code

3. Federal Employer Identification Number

4. Contract Person*Last Name Suffix (Jr., Sr., III)

First name Middle Name

Title

Business Mailing Address

City State Postal Code

Telephone Number (Include Area Code)

Email Address

* The designated contact person must have the authority to act on behalf of the nonprofit institution of highereducation submitting this application.

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5. Attach the Research Endowment Plan for which the NPIHE is seeking matching fundsunder the Maryland E-Nnovation Initiative Program (the “Program”). The ResearchEndowment Plan is intended to provide the Maryland E-Nnovation Initiative FundAuthority (the “Authority”) with an explanation of the NPIHE’s comprehensive researchobjectives and plans to build competitive research infrastructure in the specified scientificand technical fields of study designated by the Authority in the regulations for theProgram, as well as comprehensive measures for achieving this goal. NPIHEs may submitthis Research Endowment Plan by filling in responses in the spaces provided below or byattaching a separate document responsive to of the items listed below. If the NPIHEelects to attach a separate document, the NPIHE should (1) indicate that a separatedocument is attached in each of the spaces provided below and cross reference thesection and page number references where the responses are located in the separatedocument; and (2) map its responses in the separate document directly to the sectionnumbers set forth below.

a. Provide an executive summary of the Research Endowment Plan. The NPIHE shallcondense and highlight the contents of the Research Endowment Plan submittedwith the Application.

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b. List and describe the field(s) of study covered by this Research Endowment Plan.See the Program regulations for the scientific and technical fields of studycurrently designated by the Authority as eligible for expenditure of endowmentproceeds under the Program.

c. Describe the NPIHE’s current research initiatives in the fields of study set forth inthe response to Section 5a above.

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d. Indicate (i) the total amount of matching funds to be requested from the Programby the NPIHE under this Research Endowment Plan; and (ii) the amount of theQualified Donation(s) supporting this allocation of matching funds. Please notethat the minimum amount of a donation (or bundle of donations) is $500,000 inorder for such donation (or bundle of donations) to be a Qualified Donation. See§6-613 of Economic Development Article, Title 6, Subtitle 6, Annotated Code ofMaryland (the “Act”) and the Program regulations for additional guidanceregarding the requirements for a Qualified Donation.

Matching Funds Requested: $_______________

Qualified Donation(s): $_______________

e. Describe the proposed uses of the matching funds requested by the NPIHE withrespect to this Research Endowment Plan. See §6-614 and the Programregulations for guidance regarding the eligible uses of endowment proceeds.

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(i) Explain how the proposed uses of the endowment proceeds described above satisfies the criteria for eligible uses of endowment proceeds under §6-614 of the Act.

(ii) Describe the anticipated costs associated with the proposed uses of the endowment proceeds described above.

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(iii) Explain how the proposed uses of the endowment proceeds described above furthers the purposes of the Program and addresses the research needs of the NPIHE in the designated field(s) of study covered by this Research Endowment Plan.

(iv) Identify any specific disciplinary hires to be made with the endowment proceeds, if known at the time of this Application. If specific information about anticipated disciplinary hires is not known at the time of this Application, the NPIHE should provide a profile of such anticipated disciplinary hires, including the manner in which such anticipated disciplinary hires will satisfy the requirement of §6-614(c) of the Act.

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f. Identify the name of the research endowment into which the Program funds willbe deposited. Attach evidence of the establishment of the designated researchendowment.

g. Describe how this Research Endowment Plan will play a role in achievinginstitutional research objectives in the designated fields of study covered by thisResearch Endowment Plan and the Research Endowment Plan’s relation to andimpact on the colleges, schools, departments, centers, institutes or other academicunits proposed, currently under development, or currently operating at the NPIHE.

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h. Describe the current or proposed collaborations, particularly with otherinstitutional partners, that play or will play a significant collaborative role inachieving institutional objectives in the designated field(s) of study covered by thisResearch Endowment Plan.

i. Describe and analyze possible strategies to enhance the NPIHE’s current researchinitiatives in the designated field(s) of study covered by this Research EndowmentPlan.

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j. Describe and evaluate how this Research Endowment Plan furthers the purposesof the Program’s goals and the research needs of the NPIHE in the designatedfield(s) of study covered by this Research Endowment Plan.

k. Attach documentation that demonstrates an interest on the part of a donor tomake a Qualified Donation. For purposes of this Section 5j, acceptabledocumentation includes a gift or donor agreement signed by the NPIHE and thedonor, provided that the donation provided for thereunder must otherwise meetthe requirements for a Qualified Donation. See §6-613 of the Act and the Programregulations for guidance regarding the requirements for a Qualified Donation.

Title, date and parties to attached agreement evidencing an indication of interest by donor:

____________________________________________________________________

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6. Oath and Signature

Under penalties of perjury, I declare that I have examined this Application, and to the best of my knowledge, information and belief, it is true and correct as of the date hereof.

Name of NPIHE: ______________________________

By: _________________________________ ____________________

Name: ___________________________ Date (mm-dd-yyyy)

Title: _____________________________

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INSTRUCTIONS

GENERAL INFORMATION

1. Form 1 (Application for Allocation of Matching Funds) must be completed by the NPIHE and approved by the Authority priorto the first submission of Form 2 (Request for Disbursement of Allocated Matching Funds) by the NPIHE in a fiscal year.

2. The Submission Dates for Applications are June 1 and November 1. Applications must be received by the Authority no laterthan 4:00 p.m. on such dates; requests for extension of this time and date will not be granted.

3. NPIHE should submit one (1) manually executed original application and one (1) electronic version (in either Word or PDF formats) of the Application.

4. Applications should be delivered to the following address:

Maryland E-Nnovation Initiative Fund Authority World Trade Center 401 E. Pratt Street – 17th Floor Baltimore, Maryland 21202

In addition to the required hardcopy application, please submit an electronic version in Word or PDF format via email to Patricia Ford at Patricia.Ford@maryland.gov.

5. Public Information Act Notice. NPIHEs should be aware that all information submitted in or accompanying an applicationmay be subject to the provisions of the Maryland Public Information Act (General Provisions Article, Title 4, Annotated Codeof Maryland). The NPIHE should clearly identify those portions of its Application, including the Research Endowment Plan,which it considers confidential and/or proprietary commercial information or trade secretaries and provide justificationwhy such materials, upon request, should not be disclosed by the State under the Public Information Act. NPIHEs areadvised that, upon request for this information from a third party, the Authority is required to make an independentdetermination whether the information must be disclosed.

AUTHORITY REVIEW AND APPROVAL PROCESS

1. The Authority will review each application for compliance with the Act and the Program regulations.

2. If the Authority determines that an Application is not responsive, the Authority shall notify the NPIHE of the deficiency, andthe NPIHE shall have five (5) business days to cure the deficiency.

3. The Authority shall provide notice to the NPIHE of approval or rejection of an Application, including the ResearchEndowment Plan submitted with the Application, including any allocation of matching funds, within 60 days after theAuthority deems the Application complete. If an Application is not approved, the Authority shall include the reason(s) theApplication could not be approved.

4. NPIHE should note that the Authority may allocate all of the matching funds available under the Program to applicationsreceived for the June 1 submission date. There can be no guarantee that funds will be available under the Program forallocation to applications received after the June 1 submission date.

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