Program Funding Request
Program Funding Request
Your name
First
Last
Email
Affiliation (student, faculty, staff)
Today's date
/
MM
/
DD
YYYY
Date of program
/
MM
/
DD
YYYY
Name of organization or office
Budget Sheet
Guest honorarium (outside presenter, lecturer, performer)
$
.
Dollars
Cents
Travel (airplane, train, SEPTA, cab, gas, bus, etc.)
$
.
Dollars
Cents
Lodging
$
.
Dollars
Cents
Food (meals, snacks, candy, water, soda, etc.)
$
.
Dollars
Cents
Registration or tickets
$
.
Dollars
Cents
Subtotal
$
.
Dollars
Cents
Subtract funding from other campus sources
$
.
Dollars
Cents
Subtract student contributions
$
.
Dollars
Cents
Total remaining (the amount you are requesting from OMA)
$
.
Dollars
Cents
Program goals (at least three)
Event statement describing the nature of your event and how it relates to the OMA mission of equity, social justice, inter-group dialogue/understanding and leadership development. Also state how this event will meet your organization's goals.
How should funds be dispersed?
Check request
Direct payment
Funds transfer
Reimbursement
Who should receive the funds? (Please include full name and address including city, state, and zip code.)
Note: If funding is granted, we request that you add "Office of Multicultural Affairs (OMA)" as one of your sponsors or funding sources. You must make an appointment to see Frederic to discuss your program before your request is approved. You will also be required to submit a program evaluation form within one week after your program.
Photographing Events –We request that you take pictures of your programs and email them to Deborah and Frederic for use on the website.
