HealthFull Words Fund Application

Please review the HealthFull Words Fund Criteria before completing this application to ensure your program is eligible for funding consideration. Contact WesWELL with any questions. The quality and completeness of your application may impact whether your application is approved for funding or not.
 

Event Description

Program Name or Title
Program Day/Date
Program Time
Program Location
   
Health topic(s) addressed by this program (check all that apply)

Other topics:
 

Contact Information

List the name of one or two contact people. They will receive notification on funding decisions by email.

Name
Email
Phone
   
Name
Email
Phone
   

Program Sponsors & Collaborators

List the student organization(s) involved in planning this program.

Program Sponsor
Collaborator 1
Collaborator 2
Collaborator 3
Collaborator 4
Collaborator 5
   
Other than funding, how can WesWELL and the Peer Health Advocates provide support for your program? (i.e. tabling, discussion facilitators, etc.)
   

Event Details
1. Describe the proposed program. Include specific planning details, information on the presenter, the schedule or agenda, and any other relevant information that would be helpful in deciding whether to fund your program or not. Please do not simply paste in the speaker's biography with no other information; provide details!

 
 
2. How is this health topic relevant to Wesleyan students?

 
 
3. What health knowledge or skills will the audience gain by attending this program?

 

 

Funding Request

Programs with multiple sponsors/collaborators may request a maximum of $200.
Individual groups or students may request a maximum of $100. 

   
Have you or are you
planning to apply for
funding from the SBC?

   
Total Estimated Program Costs
   
Amount requested from
the HealthFull Words Fund
   
Amount of other Funding Sources
List by dollar amount and name
of office, fund, or person
(i.e. $500 from the SBC or
$250 from Student Program Fund).



   
Group Account Number (or TBD)
List the name and account number of the WSA student group to which funds should be disbursed, if your application is approved. List TBD if you do not know the number yet.
 		 Group Name

Account Number (or TBD)

   

Verification

By clicking submit, I confirm that, to the best of my knowledge, all the information in this application is true and correct. If a grant is made, the organizers named on this application agree to comply with all the HealthFull Words Fund requirements as stated in it's Criteria and with all University policies and procedures as they apply to disbursement of funds and to scheduled programs. Failure to comply will result in denial of funding.

 

revised 12/06/2011