Funding Request Form Personal Information First Name * Last Name * Phone Number * Hinman Box * Department * Email * Reason for Funding * - Select -Classroom EnhancementConference Travel and ResearchEvent Co-SponsorshipManuscript Review Classroom Enhancement Course Name * Dates and Time of Visit * Name of Guest Speaker * Title of Guest Lecturer Talk * (OR, if your request is for something other than a speaker for a class, please provide a brief description) Background of Proposed Speaker Please include short bio. Attach CV Upload Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Conference Travel and Research Project Title * Dates of travel or time frame of research * Location Project Goal/planned outcomes: * Please provide a description of the research to be undertaken, or abstract of paper(s) to be presented. If you would like to attach a copy please attach in the next question. Attachment Upload Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Event Co-Sponsorship Name of Event * Date of Event * Time of Event * Audience * Undergraduate Graduate Faculty Staff General Public Who is your intended audience? The nature and purpose of the event (feel free to attach a sheet with additional information) * Attachment Upload Files must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Manuscript Review Title of Manuscript * Budget Expenses * Please list the expenses of Honorarium, Travel, Accommodation or any other expenses. Other co-sponsor(s): * List other sources of funding, and the monetary amount they are contributing and/or administrative support. List whether funds are pending or approved. Please notify the Dickey Center of any changes. The Center may need to withdraw co-sponsorship if conditions are altered. Funding from other sources List of the individuals or organizations,if any. Please list whether funds are pending or approved. Total of Budget * Amount of Funds requested from the Dickey Center: * Submit