Copy Paste link to access OHSU All-Hill Funding Request Form. Or print and use the form below.
REQUEST
FOR FUNDING FROM THE OHSU ALL-HILL STUDENT COUNCIL
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
FOR STUDENT COUNCIL USE:
Amount approved by student council: $________________________________________________________________
