Please complete and return this form to the Office of Development. The form can be printed and submitted by mail, or returned electronically by using the submit button at the end of this page. You will receive a resonse after your request is reviewed by Craig Glogowski, Director of Development.

Name of Project or Program:

Dept. / Org. / Club:

Objective / Dollar Goal:

Purpose for Funds:

Method of Fundraising:

Time Frame:

Names of Individuals engaged in fundraising activity:

Fundraising history (list any current or past sponsors & contributors to your program):

Have you obtained a Director/Dean signature?

	Yes
	No

Campus Liaison (applicant) Information:

Name:

Address:

Phone:

E-Mail: