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Student Initiative Department Grant Application 2009 - 2010 Contact Information: Name(s): _______________________________ Group: _________________________________ Phone Number(s): ________________________ Email Address(es): _______________________

How much money are you requesting? _________________________________ When would you need the money? _________________________________

Summary: What your project/event/idea is, when it is, etc. Be sure to include how the money you are requesting will be spent, and where the event will be held. (Attach additional pages as needed)

Benefit to students/Department: How do you see this event/project/idea benefiting students/Department? (Attach additional pages as needed)

Will this event involve alcohol? Have you received money from the Dept. in the past? Do you have promotional material? (If so, please attach a copy)

Yes _____ Yes _____ Yes _____

No _____ No _____ No _____

Budget: YOU MUST ATTACH A BUDGET! Your budget should include a breakdown of your expenses, and all your sources of income for the event. If you have corporate sponsorship, include the company names and the amount of sponsorship from each. Does your group have an internal account at Queen’s? If yes, please submit your account number.

Yes _____

No _____

______________________________________

If the group account is off-campus, who should the cheque be made payable to, and provide the mailing address. ______________________________________________________________________

______________________________________________________________________________ -------------------- For Office use only -------------------Department of Electrical and Computer Engineering Funding granted?

Yes / No

Date: ________________

Amount $ __________

Inclusion as co-sponsor?

Yes / No

Contact: Kendra Pople-Easton – kendra.pople-easton [at] queensu.ca


donationsfundform09-10