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Wellness Request Form
This form is to request Wellness funding for events and activities. The submission will be reviewed by Camille in Student Affairs and she will contact you to move forward.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Email
*
Your answer
Phone
Your answer
Grad Year
*
Your answer
Student Organization or Department
Please list PI and Department if applicable
Your answer
Co-Hosting Groups
Only one group needs to submit funding request
Your answer
Event Name
*
Your answer
Location
*
For On-Campus Events put Room # or TBD if unknown
Your answer
Event Date
*
For On-Campus Events no more than 2 events allowed to occur at the same time
MM
/
DD
/
YYYY
Event Start Time
Time
:
AM
PM
Event End Time
Time
:
AM
PM
Event Description
*
Please include why this event is apllicable for wellness funding
Your answer
Total Funds Needed
*
Your answer
Requested Funds from Wellness
*
Your answer
Please LIst All Outside Sources of Funding
*
Include Funding Source and Amount
Your answer
Additional Comments
Your answer
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