Student Affairs Program Coordinating Council 2008-2009
Request for Sponsorship

* All fields are required

Contact Information

First Name:
 Last Name:
 Phone Number:
 Email:
 UI Affiliation:
 Name of organization:

Event Information

Title of proposed event:
 Proposed Date of Event: (MM/DD/YYYY)
 Proposed Time:
 Location of Event (has venue been reserved?):
 Target audience:
 Expected number to participate in this event:
 Number of UI students expected:
 How will this event by publicized?:
 How will you insure the public made aware of this event?:
 Have you received funding for this event from the Program Coordinating Council in previous funding periods?
Yes
No If yes, when and how much?

Other Information

What exactly do you propose to do?
 How do you see this program as relevant to the goals of the Student Affairs Programming Coordinating Council?
 Provide any information you believe would be helpful to the committee such as collaborations with other units, uniqueness of your event, or if recurring how it is different:
 If you are requesting funds for food please provide a justification:

If your request is over $2,000 your event must meet at least three additional criteria.
Please detail how your event meets three of the following criteria:

Other Information

1. How does your program demonstrate collaboration in the planning and execution stages among two or more RSO’s, groups, departments, etc.?
 2. What is your educational component?
 3. How is your event aligned with one or more of the following strategic initiatives?
  • Safety (i.e., spatial, interpersonal, environmental, healthy social networking, etc.)
  • Special Populations and campus engagement (i.e., veterans, transfer, international or other students)
  • Diversity
4. What is the potential to attract a large audience?
 5. What is the potential for long-term impact or change?
 6. What is the best practice you wish to demonstrate?

**If a speaker/performer/special guest is being paid:a bio, vita, or press release info MUST be submitted. Please provide copies of all contracts or agreements with Speakers/Performers/Special Guests.**

Attachments can be sent via email to Belinda De La Rosa or hand delivered to 300 Turner Student Services.

Attachments will be sent via email
Attachments will be dropped off

PCC does not fund any event in its entirety. Please tell us where you will receive the balance of the funds in the Projected Income Sources, Amounts, and Information below

Proposed Budget

PROJECTED INCOME SOURCES, AMOUNTS, AND INFORMATION
Requested From Category Amount Requested Amount Approved Amount Pending
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
PROJECTED EXPENSE SOURCES, AMOUNTS, AND INFORMATION
PROJECTED EXPENSES
TOTAL BUDGET
 PCC Request
Advertising $ $
Decorations $ $
Supplies $ $
Program Printing $ $
Equipment Rental $ $
Space Rental $ $
Honorarium for Speaker/Performers/Special Guest** $ $
Transportation for Speaker/Performers/Special Guest $ $
Lodging for Speaker/Performers/Special Guest $ $
Meals for Speaker/Performers/Special Guest $ $
Security $ $
Food
(only if integral to the program—and justified above)		 $ $
Other
(specify)  		$ $
Other
(specify)  		$ $
TOTAL PROJECTED EXPENSES $  
GRAND TOTAL (projected expenses - approved income) $  
YOUR REQUEST FROM PCC   $