REQUEST FOR FUNDING FORM

Please let us know when and why you need funding.

DATE DATE / MM / DD YYYY
PRIMARY CONTACT NAME PRIMARY CONTACT NAME First Last
Email
DEPT/SCHOOL/ORGANIZATION/AFFINITY GROUP
AMOUNT REQUESTED $ Dollars . Cents
OTHER FUNDING SOURCES
PLEASE PROVIDE A DETAILED BREAKDOWN OF TOTAL PROGRAM COSTS
PROVIDE A BRIEF DESCRIPTION ABOUT THE PROGRAM/INITIATVE YOU ARE SEEKING FUNDING FOR & INCLUDE INFORMATION ABOUT THE VENDOR OR PRESENTOR ALONG WITH THEIR BIO
WHO IS THE PROGRAM OPEN TO
ANTICIPATED DATE, TIME & LOCATION OF PROGRAM/INITIATIVE
Questions?

PLEASE CONTACT LATRINA PINKARD @ 585-395-2024 lpinkard@brockport.edu