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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.
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First Name
MI
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Last Name
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Address 1
Address 2
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City
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State
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Postal Code
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Phone
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Email Address
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I am
Student
Faculty Member
Staff Member
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Employee ID # or Student #
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Job Title or Student Status(Undergraduate, Graduate, Professional)
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Campus Location
Downtown Denver Campus
Anschutz Medical Campus
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Name of Department/Group/Organization
Event Information
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Event Title
Performer(s)/Speaker(s) name(s)
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Event Date(s)
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Event Time(s)
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Event Location(s)
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Projected Audience (number)
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Event Format
Lecture/Speaker
Performance
Workshop
Conference
Other
If other
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Event - Designated Budget and Budget Breakdown (Total cost in dollars)
0/5000 words
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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
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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
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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)
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Indicates Response Required