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.
Email *
Full Name *
Email *
Phone
Grad Year *
Student Organization or Department
Please list PI and Department if applicable
Co-Hosting Groups
Only one group needs to submit funding request
Event Name *
Location *
For On-Campus Events put Room # or TBD if unknown
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
:
Event End Time
Time
:
Event Description *
Please include why this event is apllicable for wellness funding
Total Funds Needed *
Requested Funds from Wellness *
Please LIst All Outside Sources of Funding *
Include Funding Source and Amount
Additional Comments
Submit
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