Funding Request Form

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Funding Request Form

Below is the funding request form; please complete this form to the best of your ability. Please note that the fields marked « are required. When you have finished, click "Send Form" to submit your request.

Requester's Information

Name «

Department or Organization Name «

Phone Number «

E-Mail Address «

Your Role with the College «

Faculty	Staff
Administrator	Student
Other

Is Your Organization a Student-Run Organization or Club «

[ Yes ] [ No ]

If Yes, Who is the Faculty, Staff or Administrator Moderator

Moderator's Contact Information

Please include department, phone number and e-mail address.

Event Information

Event Name «

Event Type «

Date and Time «

Location «

Primary Speaker / Performer «

Speaker's Background «

(limit 1,500 characters)

Description of Event «

(limit 1,500 characters)

Publicity Plan for Event «

(limit 1,500 characters)

Target Audience «

Please include the projected / expected attendance. (limit 1,500 characters)

Describe How This Event Supports the Vision and Mission of the College Diversity Committee «

(limit 1,500 characters)

Budget Information

Honoraria Proposed

Travel Proposed

Lodging Proposed

Advertising Proposed

Additional Costs Proposed

Funds Requested from the College Diversity Committee «

Funds Requested from Other Sources

If Requesting Funds from Other Sources, Please List Sources

Total Budget «

Additional Information

What Is the Deadline for This Decision

Comments

Fields marked with "«" are required.

Loyola University Maryland | 4501 N. Charles Street, Baltimore, MD. 21210
410-617-2000 | Weather Line: 410-617-2223

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Loyola University Maryland | 4501 N. Charles Street, Baltimore, MD. 21210
410-617-2000 | Weather Line: 410-617-2223