Chapter/ Student Chapter Funding Request

Chapter/ Student Chapter Funding Request

Use this form to submit your request for student chapter or professional chapter funding!

General Information

Name of EMBS Chapter:*

Chapter Contact Name:*

Contact Email Address:*

IEEE Section Name

Permanent Mailing Address:*

City:

State / Province / Region:*

Country:*

Select or enter value

Event Information:

Date of Event:*

Name of Event:*

Type of Event:

Select

Location: (where will the event be held or broadcasted from virtually)

Amount Requested in $ USD:*

Number of Expected Attendees:*

I understand that for this request for funding to be processed, I must submit either electronic or paper copies of letters confirming matched funds from all sponsors to Kelly Phillips Shields in the EMBS Executive Office (k.phillipsshields@ieee.org)*

Please attach the following information:

- Full description of the event

- Commitment letter from source of matching funds

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