President’s Fund for Student Diversity and Inclusiveness Application
STUDENT GROUP INFORMATION
Student Organization/Club: ______
Number of Student Members: ______Number of non-student members: ______
Staff/Faculty Advisor/s: ______
Is your organization/club registered through the UCCS Student Life and Leadershipoffice at UCCS? Yes No
NOTE: In order to be considered for funding, funding sources require that a student group have be registered and, in good standing, with the university prior to being considered for funding.
EVENT CONTACT INFORMATION
Preparer/Event Contact: ______
(Must be a fee-paying student)
Student ID Number ______-______-______
Address: ______City: ______Zip: ______
Primary Phone #: ______Secondary Phone #:______E-Mail: ______
Travel Information (If applicable)
Description of Travel: ______
Conference or Event Name: ______
Method of Travel: ______
Additional Information: ______
______
Please list the full names and student Id numbers of all students traveling. (All travelers must be fee paying students and members of the registered organization/club listed above)
EVENT INFORMATION
Title of Event: ______
Event Format:Speaker Performance Workshop Educational Conference
Other Please explain: ______
Date(s) of Event: ______Time(s): ______
If on campus, is the space reserved? Yes No If yes, Event Location: ______
Facility Capacity: ______Projected Attendance: ______
Has your club/organization filled out the necessary Event Registration Form or Travel Packet with the Student Life and Leadership office? Yes No
If awarded President’s Funds you will not be able to access the funds until you have complied with the policies and procedures associated with events and/or travel through the Student Life and Leadership office.
Is this event open to all students? If No why? ______
Is all documentation determining the actual cost of the expenses available with this packet? Yes No
If no, please explain:
QUESTIONS
Please answer the following questions regarding the event your group wishes to sponsor.
In a brief summary, please explain your club or organizations viewpoint on diversity and inclusiveness. Please incorporate strategies that you feel should be implemented to help achieve a more diverse and Inclusive environment on the University of Colorado Colorado Springs campus.
Please provide a brief synopsis of your event. Be sure to include specifically what the event will entail and what goals you have set. (If you are attending a conference, please attach a copy of the conference brochure and any other relevant travel estimates)
How will this event contribute to the Vice Chancellor of Diversity’s goal of enriching a Diverse and Inclusive environment on the UCCS campus? It is recommended to focus on both the individual and the wider campus community in answering this question.
How did you obtain the extra funding that will be used to support this event? (i.e. Fundraising,SGA, department support, etc.)
If this event has occurred in the past, please briefly describe the success of it. Please include any changes that you have made to improve the event based on past events.
If you plan on collaborating with any other organizations please list them below. In addition, please list the tasks/efforts that each organization/club will be contributing to this event.
After the event occurs, you are required to submit a report outlining event outcomes and successes. Do you agree to complete this requirement? Yes No
Proposed Event Budget
It is important to the President’s Fund that all event proposals are given fair and equitable consideration over all proposed events and activities. Considering this, it is important to make sure that all forms and budgets filled out are as detailed as possible. Using club funds and other funding sources will increase the likeliness that events will be funded. If you have any questions about this form feel free to contact the MOSAIC office at .
For which category are you requesting Presidents Funds for Student Diversity? If any line does not apply to your event please put n/a on that line. Please give a detailed explanation of how the funds, if awarded, will be used in each category. This section corresponds to the supplied materials that show cost quotes. Please place a “0” on any lines that do not apply. This needs to reflect the whole cost of the event, as well as other available funding sources.
EXPENSE CATEGORY / DETAILS / TOTAL COSTFood and Beverage
Advertising
Speaker
Decorations
Conference Registration
Lodging
Airfare
Miscellaneous
Miscellaneous
Total Event
Expenses
Funding From
Other Sources
Total President’s Funds Requested
Multicultural Office for Student Access, Inclusiveness and Community
University Center 110 •1420 Austin Bluffs Pkwy•Colorado Springs, CO 80918
t 719-255-3040•