Request Funding

Request Funding

Today's Date:

Email Address:

Full Name:

Department or Group:

Title of Event/Program:

Event Speaker(s) and Bio(s):

Proposed Date:

Proposed Time:

Proposed Location:

Amount Requesting:

Total proposed cost of event:

List co-sponsoring organizations and/or campus departments solicited and/or confirmed:

What are your specific goals? Briefly describe how this program is aligned with the mission of the Matrix Center:

Comments: