RA Name:
Date: (dd/mm/yyyy)
Co-Sponsorship: Please choose one Yes No
Program Title:
Category:
Program Date: (dd/mm/yyyy)
Program Time:
Program Location:
Total Anticipated Cost:
Your Contribution:
Target Population:
Anticipated Attendance:
Source of funds:
Materials, items, speakers... and anticipated cost of program:
Co-Sponsorship, please list individual responsibilities of those involved:
Room/Equipment reservation and date confirmation:
Brief description of the event:
What are your objectives in conducting this program?
Types of publicity used? (ex: flyers, cable/voice mail announcement and date that it will be posted or announced)
Type of Program: Please choose one Social Educational Welcome All Staff
*Remember you will only be reimbursed for up to and not to exceed the dollar amount asked for on this form. Please do not go over your own budget. *You are only allowed to co-sponsor up to two programs per semester with other RA's and/or Organizations. All Programs are subject to RD approval. You may be contacted to discuss or resubmit a program in the event that it must be altered in some way.
