UNM Health Sciences Office for Diversity, Equity & Inclusion Sponsorship Request Form

This form is used when an entity, organization, or department wants to request one-time sponsorship funding from the UNM Health Sciences Office for Diversity, Equity & Inclusion (UNM HSC DEI) for a DEI or health science-focused event, program, or other activity that benefits UNM Health Sciences students, staff and/or faculty.

For best consideration of sponsorship, please apply at least 45 days prior to the event date(s).

A DEI team member will confirm the receipt of your request. Due to the number of requests received by our office, we must limit the amount of support to $250.00 per request

***Please note that funds are only for DEI or health science focused activities and are limited annually based on budget availability.***

REMINDERS

UNM HSC DEI MISSION: To advance inclusivity, diversity, & equity throughout the Health Sciences Center and New Mexico via capacity building, sustainable programs, and collaborations. We also strive to promote inclusivity and diversity throughout the UNM Health Sciences Center as well as seeking to engage communities across New Mexico to advance health equity through programs and sustainable, collaborative partnerships.

URGENCY: If your request is URGENT, please be sure to click on the URGENT FLAG in the form below! We will do our best to meet your needs, but be aware our review process does take some time, so please try to plan ahead and send in your request EARLY!

REQUESTING INDIVIDUAL/ORGANIZATION INFORMATION

Requestor Name

Please enter your FIRST & LAST NAME

Contact Email

Please be sure you enter a valid email address that you check regularly

Contact Phone

Please enter your phone number in this format XXX-XXX-XXXX

Organization Requesting Sponsorship

The organization, department, or office requesting the sponsorship

Organization Type

Choose the option that best applies.

EVENT/PROGRAM/ACTIVITY INFORMATION

Event/Program/Activity Title

What is the name of the program/event/conference for which you are requesting funding?

Location of Event

List campus or community location, with address if available

Date(s) of Event

Example: April 1-3, 2024

Time(s) of Event

Example: 8am-5pm

Is this a DEI-focused event/activity?

Yes

Is this a health sciences focused event/activity?

Yes

Description of Activity/Event

Limit to 100 words or less.

We are only able to sponsor events or activities that are diversity, equity & inclusion (DEI) focused, and/or health sciences focused. Please share here how your event or activity is DEI and/or health sciences focused.

FUNDING REQUEST SPECIFICS

Total Requested Funding Amount

Please format your response as follows $00.00 (ex: $250.00). Maximum request amount for HSC Professional Development Funds requests is $250.00.

Total Cost of the Event

What is the estimated total cost of the event/activity (if known)

Have You Requested Financial Support from Other UNM Departments/Units for the Event?

Yes

Has UNM Health Sciences Office for Diversity, Equity & Inclusion Financially Supported You in the Past?

Yes

If funding is approved for this event/activity, do you agree to add our office logo to your promotional materials?

eg: UNM HSC DEI logo added to the event flyer or announcement.

We will email the logo file with funding approval notification.

Yes

If you are a UNM entity, please provide the index to which funds may be transfered if the request is approved.

URGENCY DETERMINATION

If you require an approval status response in fewer than 10 working days, please check the box. If not, please leave the box blank.

Is This Request URGENT?

What is Latest Possible Notification Date?

What is the latest date by which you need to receive approval status notification from OfDEI?

mm/dd/yyyy

FILE UPLOADS

You are welcome to attach files related to this request and a variety of file types are acceptable (PDF, Word, Excel, JPG, PNG, etc.). Examples might include flyers, annual reports, etc.

Drop your files here

Send me a copy of my responses

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