WSGA Funding Request Form

Organization

Organization Name *

Agency Account # (if unknown, call 785.670.2031) *

Contact

Email *

Phone *

Organization Sponsor

Email *

Phone Extension *

Activity and/or Project

Activity and/or Project *

Event Date, Time, and Location

Event Location *

Explanation

Explanation of Activity/Project *

Benefits

How will the Activity/Project benefit the Organization and Washburn? *

Students

Number of Students Attending *

Fundraising

Fundraising Completed (amount raised for this activity and/or project within the past semester) *

Community Service

Community Service completed (within the past semester) *

Attachments

Instructions
1) Roster approved by Student Activities and Greek Life. If the entire organization is not participating, place an asterisk next to the names of people attending this activity and/or project

2) Validation for all estimated costs listed on the spending breakdown.

3) An itinerary for the event from start to finish.

1) Roster (see instructions above) *

2) Validation (see instructions above) *

3) Itinerary (see instructions above) *

Travel (next 5 sections)

Fill out every box. If not applicable, please put "N/A"

Personal Vehicle Mileage (Input how many miles driven roundtrip. [Restriction: University's mileage]) *

Airfare (Total cost for tickets) *

Rental Vehicle Gas *

Rental Vehicle Cost *

Lodging, Registration & Food

Fill out every box. If not applicable, please put "N/A"

Lodging (Total cost for lodging) *

Registration (Total cost for registration) *

Food (Total cost for food. [Restriction: $750 max or $20/day/student]) *

Explanation for Lodging and Food

Advertising, Speaker & Apparel

Fill out every box. If not applicable, please put "N/A"

Advertising (Total cost for advertising. [Restriction: $300 max]) *

Speaker Fee (Total cost for speaker.) *

Apparel (Total cost for apparel. [Restriction $300 max]) *

T-shirt JPEG (Please upload a JPEG of your t-shirt design. [If not applicable, do not upload anything])

Explanation for Advertising, Speaker & Apparel

Other Costs

Fill out every box. If not applicable, please put "N/A"

Other *

Totals

Total Cost *

Total Requested ($3,000 max [No more than $2,000 max or 75% of total cost or $300 per person for any off campus events]) *

Wufoo

Organization

Contact

Organization Sponsor

Activity and/or Project

Event Date, Time, and Location

Explanation

Benefits

Students

Fundraising

Community Service

Attachments

Travel (next 5 sections)

Lodging, Registration & Food

Advertising, Speaker & Apparel

Other Costs

Totals