University of Connecticut |
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Human Rights InitiativeApplication for Event SupportName of Applicant (Person/Organization): ________________________________________ Contact Person: ______________________________________________________________ Telephone: ______________________________Fax:________________________________ Address: ___________________________________________________________________ Email: _____________________________________________________________________ Name of Event/Program: ______________________________________________________ Total Amount Requested: $____________________________________________________ Purpose: Honorarium, $______________________ Travel, $_________________________ Other (describe): ____________________________________________________________ FRS Account where funds will be deposited: _______________________________________ Other sources of funding: _____________________________________________________ Description of Event/Program: On a separate sheet, describe the significance/importance of the Tentative date for event/program: ________________________________________________ Proposed venue: _______________________________________________________________ Please indicate if you have approached the speaker or the likelihood that he/she will accept: ____________________________________________________________________________ Signature of Representative Applying: _______________________________ Date: __________ Signature of Dean/Department Head: ________________________________ Date: __________
Application Deadline: March 31, 2008Send Application to: Ann Galonska If you have any questions, contact Tom Wilsted at (860)486-4501 or tom.wilsted@uconn.edu. This page is maintained by T. Wilsted. |