University Diversity Committee - Request Event Funding

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Event Funding Form

University Diversity Committee Request for Event Funding Form

2008/09 Deadline - Friday, May 15, 2009

Requester


Organization, Club or Department:
Requesting Individual (CSUSB faculty or staff):
Phone:
Email:

Event Specifics

Description of Event or Program:
Proposed Date:
Time of Event:
Alternate Date (if applicable):
Event Location:
Reserved?:
Funding Requested (not to exceed $1000):
Specific Item(s) to be funded:

Projected Budget Summary

Item	Budget

Please list other sources of funds requested or obtained

Department:
Amount Contributed:
Other Source(s):
Amount Contributed:

How will the proposed event address issues of diversity specific to CSUSB?

How will the event address the theme of "Unity within a Diverse Community"?

Who is the target audience for the proposed event?

How will this event be advertised?

If a speaker or performer is to be paid with requested funds, please provide the following information plus a resume or other information to determine guest's area of expertise:

Speaker's first name:
Speaker's last name:
Title:
Address:
Telephone:

I hereby agree to adhere to the funding guidelines described. I also agree that the University Diversity Committee will be listed as a program/event sponsor on all publicity related to this event.

E-mail Address (Signature):
Date:

Note: This form must be complete for consideration of the request. If you wish to submit in person, please deliver Ms. Tina Valencia, CSUSB University Diversity Committee, Undergraduate Studies (UH-352).