CLDI Student Fund Request Form

CLDI Student Fund Request Form

Name/s of organizer

Student Interest Group/s Name:

Have you requested funds from your school? i.e SOM

If you answer NO, we ask that you also request funding from your respective school.

Select or enter value

Was the above request approved?

Select or enter value

How much was requested from your school?

Date funds requested from your respective school?

Have you requested funds from All Hill?

yes

If YES to above, how much was approved?

Was this event registered with Student Life?

If yes proceed. If no, please register here and proceed. Copy and paste link:

https://app.smartsheet.com/b/form/a0972097cf3b4b489457c9f6ee7669b2 Contact studentdiversity@ohsu.edu if you need assistance.

Select or enter value

Event name/ Fund request reason

Event date

Dollar amount requested

What will be purchased? Please provide a detail list of items.

Describe how this event promotes DEIBA at OHSU

Please also provide details about the event. What is it for? topic/theme? Will there be any speakers?

Have you secured a location?

Yes

No, and need assistance.

No, and need assistance..

Event location (if applicable)or weblink for event

How many people expected (if applicable):

Name of Faculty Mentor attending

Do you need assistance to make flyer?

Select