Individual Student Assistance Sponsorship Request Application

This form is for individual students who might be requesting assistance for things like conference fees, service learning trips, study abroad.

Name

Comments

Student ID Number

Title/role in group/organization (if applicable)

Phone (area code) xxx-xxxx

Type of event for which you seek assistance (check all that apply):

Conference Fee

Training or Workshop Fee

Service Learning Trip

Study Abroad

Other – Please List below:

Other events not listed above.

Name of Opportunity

Date(s)

Please provide a brief description of this program/event/opportunity/training. Include information such as purpose, number of participants and what you hope to gain by participating.

How will participating in this program/event/opportunity/training assist you in either: enhancing the mission of the LGBT Center; benefitting students served by the center; improving campus climate for marginalized groups; or celebrating/uplifting diverse

Should you receive funding for this opportunity, how might you “pay it forward” by assisting those served by the LGBT Center?

Have you requested funding from other departments, organizations or funding sources? If yes, please list the source and amount received/requested below:

Please reply to the following questions: Total cost of program/event/opportunity/training? Total amount you are requesting from the LGBT Center? Total amount you are receiving from other sources? Total amount you are personally investing?

Please enter the text.

The LGBT Center has limited funds and resources for sponsorships…please share any additional information that will assist us in considering your request.

By submitting this form, you confirm the information provided is true and accurate. Should your organization receive funding, you further agree to list the LGBT Center as a sponsor in all collateral event materials and abide by the LGBT Center’s branding guidelines.

The LGBT Center at University of Louisville

Individual Student Assistance Sponsorship Request Application