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Monday, October 13, 2014

Funding Request Form


Copy Paste link to access OHSU All-Hill Funding Request Form. Or  print and use the form below.


Conditions of Funding:
Students enrolled in the Schools of Dentistry, Medicine, Nursing, Pharmacy, Graduate Studies and PA may request funds from the All-Hill Student Council for interprofessional events.  The event must include students from more than one school program and be designed to bring students from the different schools together.   Students seeking school-specific funding should contact their Dean’s Office and School Government to make a funding request.
Funding is limited to one contribution, per student, per term, depending on availability of funds. Funding of one contribution, per student, per term is not guaranteed. Funds cannot be used for anything other than the purpose stated in the initial request

Funding for individual travel to attend professional development meetings, conferences and individual projects, are not within the scope of All-Hill
Student Council’s funding requests. Funds have been allocated to individual programs for such events. Special circumstances may be considered upon request.
Please fill out the following form and submit a detailed budget outlining the total funding and expenses of the student activity, and submit all requests to Kenneth (KC) Gilbert (gilberke@ohsu.edu) and Amelia Stoker (stoker@ohsu.edu) at least 1 week prior to monthly Student Council meeting to allow for review.   Meeting schedule can be found at: http://ohsustudent.blogspot.com

Primary Contact Person: ­­­­­­­­­________________________________________ Date:__________________

Name of OHSU Organization or Participants:______________________________________________

Mailing Address:_____________________________________________________________________________

Phone: ________________________________  E-Mail: ______________________________________

Date of Activity/Event:_________________________________________________________________

Purpose/Description of Activity or Event: _________________________________________________

Total cost of activity/event: $_______________________ Requested amount: $___________________

Please make sure that all fees, including registration or submission fees, are included in the original funding request.

Have you requested funds from your Dean’s Office and School Government prior to making this request with the All-Hill Council?
Yes: ___   Amount received? $________________________
*Please include with this request a copy of the funding request form submitted to your Dean’s Office and Student Government, showing the amount received and signature of fiscal authority.

 No:  ___   If no, please request funding from these sources before submitting a request to the All-Hill Council.       

If funding is approved, requester must submit receipts to Karen Seresun, Assistant Vice Provost for Student Life (seresunk@ohsu.edu) for reimbursement.  Original receipts, mailing address and social security number are needed to issue the reimbursement.  All funding requests take 4-6 weeks to process.

___  I have read and agreed to the following conditions of funding

___________________________________________                      __________________________       

Signature                                                                                       Date


Amount approved by student council: $________________________________________________________________

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