Request UHC-PGSUSTAINED DISCUSSION GROUP/READING GROUP

Number FUNDING REQUEST AND JUSTIFICATION FORM

(for office use)~ application must be typed, not handwritten ~

REQUESTOR:DATE OF APPLICATION:

E-MAIL:PHONE:

CO-PROGRAM PLANNERS (if any):

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[ALL REQUESTERS MUST FILL OUT THIS SECTION]

Program Title:

brief program description (a short 3-4 line “ad” for your program; 100 word max):

Dates you will meet during the term:

Proposed Program Time:

Estimated Attendance Per Event(EXACT ATTENDANCE IS NEEDED FOR READING GROUPS):

Proposed Location

*Space will be confirmed based on availability if your programming request is approved. Please rank your space options with 1 being your top choice; leave any you do not want considered blank (we recommend you list at least two options).

Cathedral of Learning, 35th Floor Common Area (capacity: 35 lecture/video style)

Cathedral of Learning, 35th Floor Classroom (capacity: 15)

Cathedral of Learning 35th Floor Reading Room (capacity: 15)

Cathedral of Learning (all of the 35th floor)

Brackenridge Hall Programming Lounge (capacity: 35)

Forbes Craig Commons Room (capacity: 100)

Sutherland Hall West Library (capacity 40)

Sutherland Hall West Programming Space (30)

Other:

FOR READING GROUP REQUESTS SKIP TO THE LIGHT BLUE BUDGET SECTION

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BUDGET PROPOSAL

REQUESTEDAMOUNT
/ APPROVED AMOUNT
(UHC-PG Committee ONLY)
1 Supplies / $ / 1 Supplies / $
2 Ticket Cost* / $ / 2 Ticket Cost / $
3 Transportation / $ / 3 Transportation / $
4 Equipment Rental / $ / 4 Equipment Rental / $
5 Facility Rental / $ / 5 Facility Rental / $
6 Fees/Honorarium** / $ / 6 Honorarium / $
7 Food / $ / 7 Food / $
8 Other / $ / 8 Other / $
TOTAL: / $ / TOTAL: / $

*Research & account for group discounts

**Speaker fees are considered for off-campus presenters, but do not make any promises or enter into any contracts prior to getting approval or you will be liable for the costs.

***Make sure you are familiar with our policies on food when requesting funds

PROVIDE AN EXPLANATION FOR EXPENSES:

All non-reading group requests must include documentation for each itemized cost. This may be in the form of a link to a website(s) and the item(s) or hardcopy estimation of the cost. Hardcopies should be delivered to the Honors College at least three days prior to the committee hearing to the attention of UHC-PG or via email to Holly Hickling ().

ALL NON-READING GROUP REQUESTS MUST INCLUDE ESTIMATION DOCUMENTATION FOR EACH ITEM

  1. Supplies:
  2. Ticket Cost:
  3. Transportation:
  4. Equipment Rental:
  5. Facility Rental:
  6. Fees/Honorarium:
  7. Food:
  8. Other:

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JUSTIFICATION INSTRUCTIONS: On a typed, separate sheet of paper, Address the following decision criteria in your justification. 1) Rationale for the program,2) Value-added impact of the program & connection to UHC3) Why the items/services that funds are being requested for are integral to the program 4) Support for estimated attendance, and 5) How you will market the event to students.

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BUDGET PROPOSAL FOR READING GROUPS ONLY

You will have $50.00/person for the term to be used for the purchase of supplies (e.g. books) and food (e.g. pizza). Please refer to the online guidelines for the UHC-PG Sustained Programs at .

REQUESTED AMOUNT
/ APPROVED AMOUNT
(UHC-PG Committee ONLY)
Number of Participants X $50.00 / $
TOTAL: / $ / TOTAL : / $

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JUSTIFICATION INSTRUCTIONS FOR READING GROUPS ONLY: On a typed, separate sheet of paper, Address the following decision criteria in your justification. 1) Rationale for the program, 2) Value-added impact of the program & connection to UHC 3) A description of what will be the themes/topics discussed 4) If purchasing books, a list of proposed books from and 5) Support for estimated attendance (list of students confirmed participating including their Pitt emails)

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In order to be considered for funding, this request must be submitted at least 30 days prior to the date of the proposed event.

By completing the above document, the requestoragrees that all programming funded through the University Honors College (UHC) must abide by the University of Pittsburgh Student Code of Conduct. All UHC-funded events must use and turn in the completed Program Participant Form to the UHC offices within 7 days of the program’s completion.