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Office of the Dean of Students

University of Illinois at Urbana-Champaign

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Student Affairs Program Coordinating Council Strategic Initiative Grant Program 2009-2010

* All fields are required

Contact Information

First Name:
 Last Name:
 Phone Number:
 Email:
 UI Affiliation:

Event Information

Title of proposed event:
 Proposed Date of Event: (MM/DD/YYYY)
 Proposed Time:
 Location of Event (has venue been reserved?):
 Target audience:
 Expected number to participate in this event by subgroups(i.e., students, faculty, staff, community members, etc):
 How will this event by publicized?:

Other Information

What is the educational component and learning outcomes you expect from your program?
 What is the potential for long-term impact, change, or best practice?
 How will this program ultimately have a positive impact on the greater student population?
 How are the all the co-sponsors collaborating on this program?
 What unit heads or their designees have been consulted about this program (please include their email address)? If funding for food is requested how is it integral to the program?

Proposed Budget

PROJECTED INCOME SOURCES, AMOUNTS, AND INFORMATION
Requested From Category Amount Requested Amount Approved Amount Pending
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
PROJECTED EXPENSE SOURCES, AMOUNTS, AND INFORMATION
PROJECTED EXPENSES
TOTAL BUDGET
 PCC Request
Advertising $ $
Decorations $ $
Supplies $ $
Program Printing $ $
Equipment Rental $ $
Space Rental $ $
Honorarium for Speaker/Performers/Special Guest** $ $
Transportation for Speaker/Performers/Special Guest $ $
Lodging for Speaker/Performers/Special Guest $ $
Meals for Speaker/Performers/Special Guest $ $
Security $ $
Food
(only if integral to the program—and justified above)		 $ $
Other
(specify)		 $ $
Other
(specify)		 $ $
TOTAL PROJECTED EXPENSES $  
GRAND TOTAL (projected expenses - approved income) $  
YOUR REQUEST FROM PCC   $