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 *

Last Name *

Address 1 *

Address 2

City *

State *

Postal Code *

Phone *

Email Address *

I am *

Employee ID # or Student # *

Job Title or Student Status(Undergraduate, Graduate, Professional) *

Campus Location *

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 *

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)