Dean`s Council funding application form.

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Biological Sciences Division Dean’s Council

Funding Application

This form should be completed and returned to Melissa Lindberg in BSLC 104B. If departmental funding is requested, the signature of the Dean’s Council representative from that department must be present at the bottom of this form. If divisional funding is requested, the signature of the Dean’s Council chair is required. Please get the approval of the Dean’s Council representative before you spend any money.

Itemized receipts must be included to receive payment

. Tape them to a separate piece of paper along with this form.

No Staples Please.

1.

Contact person

Name: UCID:

Address:

City, State, Zip

Phone : (home)

2.

The activity will be funded by:

The Dean’s Council general fund for the Division (

sub account xx01

) – if not for the entire division, at least five departments or committees must be involved. Select the departments/committees below.

A department or committee (more than one is acceptable). Select the department/committee that is involved.

BMB

xx03

BPHS

xx04

CABI

xx05

CMB/MGCB

xx06

CPNS

xx07

HGEN

xx12

DRSB

xx08

HSTD

xx13

ECEV

xx09

IMMU

xx14

EVOL

xx10

ISTP/MSTP

xx15

GGSB

xx11

MICR

xx16

MOMN

xx17

MPHY

xx18

Total amount requested:

NURB

xx20

IB/OBA

xx21

MPMM/PATH

xx19

3.

4.

Date of activity:

Please provide a brief description of the activity. Include the type of event (ex. party, journal club, weekly seminar/”happy hour”, etc); the number of students involved, type of publicity, whether it is a weekly, monthly, or one time activity; and any other information that may be relevant. If the number participating was 10 or less, please provide the names of those who attended.

5.

List the expenditures. Please submit the original receipts with this form.

Date: Signature: ________________________________________

Department/committee Representative Signature: _____________________________________

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