Qualtrics Survey | Qualtrics Experience Management

Date Special Funding Needed By:

Purpose:

Group Requesting Funds:

Total Budget for this Event:

Amount Requested of Provost:

Funding Amounts Provided by Other Entities (if applicable):

Source #1 - Name

Source #1 - Amount Requested

Source #1 - Amount Granted

Source #2 - Name

Source #2 - Amount Requested

Source #2 - Amount Granted

Source #3 - Name

Source #3 - Amount Requested

Source #3 - Amount Granted

Source #4 - Name

Source #4 - Amount Requested

Source #4 - Amount Granted

Point of Contact & Contact Info

Name

Title

Email Address

Phone Number

Event Description (who, what, when, where, etc.)

Additional Details

Additional Details
	Yes	No
Does the activity/event/project for which funds are requested have campus-wide relevance and appeal?	Yes	No
Are most attendees/beneficiaries KU Students?	Yes	No
Does this project/activity fulfill on or more of the three strategic initiatives of Jayhawks Rising? If so, list below.	Yes	No
Has the requesting unit/group demonstrated its own financial commitment to the request?	Yes	No
Does this project involve collaboration between organizations or units? If so, list below.	Yes	No
If food is being provided, is it being procured through KU Dining?	Yes	No
If this request supports an event, is it open to all KU students?	Yes	No