Funding Request Form – AS Black Women’s Health Collaborative

Submit a Funding Request

Please fill out all applicable fields. You must be an officer of your organization to request event funding. Be sure to submit your budget before Monday at 4pm. Once submitted (before the weekly deadline), you will be added to our agenda to come to our Tuesday meeting. You must send an informed representative to the following Tuesday at 4pm and be ready to answer questions from the committee about your funding request.

Organization Name*
Organization Category*
- OSL/Shoreline Registered
- Campus Department
- Graduate
- Associated Students BCU
AS Account number
Organization Lead Name
Event name*
Your name and position
Phone
Email*
How would you like to be updated on funding decisions?*
- Email
- Phone
- Both
Where is the event?*
Event Type*
When will this event be taking place?
Brief Project Description
Budget Items
Item Cost Request

Please itemize your budget using the fields below.
Other Funding Sources
Funding Source Amount

If you have received funding from other organizations, please add them here. If you have applied for funding, but do not know the outcome; please put pending next to the amount.
Attach your budget here
Drop files here or

Max. file size: 128 MB.
Include any flyers or informational pages here.
Drop files here or

Max. file size: 128 MB.
Request total*
Signature*
By signing below you are certifying that all above information is correct and accurate.

Item	Cost	Request

Funding Source	Amount