Request to Fund

Contact Information

Name: *

Phone Number: *

Email Address: *

Please indicate if you are: * facultystaffstudent

Please indicate your relationship to the university.

University Information

Please indicate the univeristy unit you are requesting funding for: *

Examples include: Mathematics, School of Management, Womens Educational Center, Student Communication Association, etc.

Project Information

Name of project:

Please list the name of your project, program, event or idea.

Date or Duration: *

Please include the tentative date or duration of the project, program or event.

Please indicate the amount of funding you would like to request: *

Please list the dollar amount or range of the amount you would like to request.

Brief Description (include key outcomes): *

Please include a description or the project, program or event.

Will there be partnerships involved? yesno

If there will be partnerships will they be with a: UM-Flint departmentCommunity Organization

Please indicate the type of funding you wish to receive: (check all that apply) Sponsored ProgramGiftSponsorshipContract

Sponsored Program -Requires a performance period, itemized budget and reporting. -There are a specific set of activities and outcomes agreed upon. -May be classified as instructional, civic engagement or other. Gift -Money given from a corporation or foundation with no return expectations (can be restricted to a particular purpose). -Projects have no start or end date. Sponsorship -Money given in return for marketing value. Contract -Negotiated agreements between the university and an outside party which contain a statement of work and are legally binding.

This section applies to sponsorships only.

What type of marketing value will be provided?

Examples include: signage, name and logo on all marketing materials, name and logo on t-shirts, etc.

Budget Information

Salary:

Fringes:

Equipment:

Supplies:

Travel/Hosting:

Postage:

Printing:

Professional Development:

Faculty Course Release:

Names of departments/organizations involved in partnership

Please list all internal and external partners that will be involved.

What are the immediate and/or long term consequences of not receiving this funding? Program ending Staff layoffOther

Contract Services:

Please provide 4-5 words for an internet search:

Comments?

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University of Michigan - Flint

Request to Fund

Request to Fund

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