Event/Professional Development Application
To be considered for a President's Diversity Fund for Development and Support Grant, please fill in the information below as completely and accurately as possible.
*
First Name
MI
*
Last Name
*
Address 1
Address 2
*
City
*
State
*
Postal Code
*
Phone
*
Email Address
*
I am
Student
Faculty Member
Staff Member
*
Employee ID # or Student #
*
Job Title or Student Status(Undergraduate, Graduate, Professional)
*
Campus Location
Downtown Denver Campus
Anschutz Medical Campus
*
Name of Department/Group/Organization
Event Information
*
Event Title
Performer(s)/Speaker(s) name(s)
*
Event Date(s)
*
Event Time(s)
*
Event Location(s)
*
Projected Audience (number)
*
Event Format
Lecture/Speaker
Performance
Workshop
Conference
Other
If other
*
Event - Designated Budget and Budget Breakdown (Total cost in dollars)
0/5000 words
*
Give a brief synopsis of content of the event and briefly explain how the event will help to enhance diversity university-wide and foster a culture of inclusion.
0/5000 words
*
What type of forum are you or your group planning to utilize to involve the campus about the information from this event?
0/5000 words
*
If you or your group has sponsored this event in the past, please summarize experiences and funding history.
0/5000 words
Authorized Signer (Full Name as AUTHORIZED SIGNATURE)
*
Indicates Response Required