Student Affairs Program Coordinating Council Strategic Initiative Grant Program 2009-2010

* All fields are required

Contact Information

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

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 by subgroups(i.e., students, faculty, staff, community members, etc):
How will this event by publicized?:
Which strategic initiative do you propose to address?:
What do you propose to do?

Other Information

What is the educational component and learning outcomes you expect from your program?
What is the potential for long-term impact, change, or best practice?
How will this program ultimately have a positive impact on the greater student population?
How are the all the co-sponsors collaborating on this program?
What unit heads or their designees have been consulted about this program (please include their email address)? If funding for food is requested how is it integral to the program?
Please briefly describe your event:

Proposed Budget

Requested From	Amount Requested	Amount Approved	Amount Pending
PROJECTED INCOME SOURCES, AMOUNTS, AND INFORMATION
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
	$	$	$
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			$

**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. (doesn’t have to be in the box)