Please fill out the following form to apply for our SansGUI Educational Grant.  For grant details, please visit our Educational Grant page.

Field names in Bold type are required fields.

• School Information

Institution Name
Department
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

• Primary Contact (Instructor)

First Name
Last Name
Title
Work Phone
FAX
E-mail

• Secondary Contact (Optional, but highly recommended)

First Name
Last Name
Title
Work Phone
FAX
E-mail

• Course Information

Course Number
Course Title
Web Presence
No. of Students	< 5 5 to 10 11 to 20 21 to 30 31 to 50 51 to 100 101 to 200 > 200
Term Begins	January February March April May June July August September October November December 2010 2011 2012
Term Ends	January February March April May June July August September October November December 2010 2011 2012
Programming	None Microsoft Visual C++ Compaq Visual Fortran Both Languages
Course Descriptions
Additional Comments

After you click on the Submit Form button below, please wait a few seconds for a confirmation page.  If you do not see a confirmation page being displayed or encounter any other problems, please notify us by sending an e-mail message to webmaster@protodesign-inc.com.