Wufoo

Funding Request Form

Please complete this form so we can get an idea about the event you want to hold on your campus.

Name * First Last
Email *

Please share your email with us in case we need to contact you.
Phone - (###) - ### ####
Address *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Please share your mailing address with us so we know where to ship materials requested.
Organization Name *

Please let us know what organization you are requesting the funding on behalf of.
School *
Description of Event *

(i.e. target audience, expected number of attendees, date, location, time, planned marketing efforts, etc.)
Goals of Event *

(i.e. activism, education, fundraising, publicity, recruitment, etc.)
How is the funding to be used? What are the expenses? *

If you're receiving funding from another source, please list that too.
Are you willing to display IHS materials at the event?

( i.e. flyers on a table)
Do Not Fill This Out