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Wellness Event Funding Request Form

Name: Full Name -
First - (Required)
Last - (Required)

E-mail: (Required)
Center and Unit/Program: (Required)
Title of Event: (Required)
Dates of Activity:Start: (Required)

End: (Required)
Location of Event: (Required)
Description of Event:
(Required - It is recommended that you create this description in another word processing program and then copy and paste the text into this field.)
Total Funds Requested:$ (Required - Numbers only, do not enter any text or special characters in this field.)
Estimated Attendance:
Event Coordinator:Would you like an event coordinator on site to help with this event?